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General NPI Number Information
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NPI Number | 1801158571
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Entity Type | Organization
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Legal Business Name | KELLI MCCARTNEY O.D. PC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 2580 MEADOWBROOK MALL
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9792
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Country | US
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Telephone | 304-842-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 1476 LAWRENCE ST
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City | FAIRMONT
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State | WV
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Zip | 26554-2355
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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 | PRESIDENT
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Name | DR. KELLI MCCARTNEY
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Credential | O.D.
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Telephone | 304-842-5544
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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 | 1077OD
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License Number State | WV
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