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General NPI Number Information
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NPI Number | 1700036357
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Entity Type | Organization
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Legal Business Name | KELLY EYE CENTER
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 10321 LUMLEY RD SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27617-8640
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Country | US
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Telephone | 919-282-1100
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Fax | 919-282-1119
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Provider Business Mailing Address
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Address Line | 10321 LUMLEY RD SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27617-8640
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Country | US
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Telephone | 919-282-1100
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Fax | 919-282-1119
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MARIDY E KNIGHT
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Credential |
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Telephone | 919-282-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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