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NPI Code Detail

MEDICARE: MR. JAMES KELLY PALMER III L.D.O.

MEDICARE: MR. JAMES KELLY PALMER III L.D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician5845-SCOH

General Provider Information

NPI Number : 1093011868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES KELLY PALMER III L.D.O.
Provider Business Mailing Address
First Line : 765 N DETROIT ST
Second Line :
City : XENIA
State : OH
Zip : 45385-1960
Country : US
Telephone Number : 937-270-2425
Fax Number :
Provider Business Practice Location Address
First Line : 765 N DETROIT ST
Second Line :
City : XENIA
State : OH
Zip : 45385-1960
Country : US
Telephone Number : 937-270-2425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2011
Last Update Date : 01/26/2011

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