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General NPI Number Information
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NPI Number | 1730856469
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Entity Type | Individual
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Provider Name | KELLEY BENTLEY OD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 19 SOLOMON RD
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City | WHITESBURG
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State | KY
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Zip | 41858-7201
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Country | US
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Telephone | 606-633-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 8044 US HIGHWAY 23 S
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City | PIKEVILLE
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State | KY
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Zip | 41501-3901
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Country | US
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Telephone |
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Fax |
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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 | 2234DT
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License Number State | KY
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