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General NPI Number Information
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NPI Number | 1720166945
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Entity Type | Individual
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Provider Name | COREY BREEN KELLY O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 555 JOHN F KENNEDY RD SUITE 665
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City | DUBUQUE
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State | IA
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Zip | 52002-5202
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Country | US
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Telephone | 563-582-5198
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Fax | 563-582-5540
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Provider Business Mailing Address
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Address Line | 555 JOHN F KENNEDY RD SUITE 665
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City | DUBUQUE
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State | IA
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Zip | 52002-5202
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Country | US
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Telephone | 563-582-5198
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Fax | 563-582-5540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2223
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License Number State | IA
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