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General NPI Number Information
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NPI Number | 1790022721
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Entity Type | Organization
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Legal Business Name | CONRAD F. KELLY, O.D.,LLC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 13750 I-10 EAST
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City | HOUSTON
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State | TX
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Zip | 77015-5929
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Country | US
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Telephone | 713-450-4446
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Fax | 713-450-4864
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Provider Business Mailing Address
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Address Line | 2352 SPERBER LN
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City | HOUSTON
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State | TX
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Zip | 77003-1553
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Country | US
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Telephone | 713-450-4446
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Fax | 713-450-4864
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. CONRAD F. KELLY
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Credential | OD
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Telephone | 713-450-4446
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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 | 3058TG
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License Number State | TX
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