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General NPI Number Information
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NPI Number | 1881702561
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Entity Type | Organization
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Legal Business Name | KELLY OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6080 SOUTH FORT APACHE SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89148
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Country | US
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Telephone | 702-309-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 TARAGATO AVE
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City | HENDERSON
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State | NV
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Zip | 89052-6597
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Country | US
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Telephone | 702-896-1864
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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. THOMAS FRANCIS KELLY
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Credential | M.D.
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Telephone | 702-309-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 9737
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License Number State | NV
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