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General NPI Number Information
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NPI Number | 1740211697
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Entity Type | Individual
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Provider Name | KELLY A BLOUNT O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 429 S 3RD ST
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City | GADSDEN
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State | AL
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Zip | 35901-5210
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Country | US
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Telephone | 256-547-8634
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Fax | 254-547-3039
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Provider Business Mailing Address
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Address Line | 429 S 3RD ST
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City | GADSDEN
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State | AL
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Zip | 35901-5210
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Country | US
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Telephone | 256-547-8634
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Fax | 254-547-3039
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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 | S570TA289
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License Number State | AL
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