MEDICARE: THOMAS J. KELLEHER OD

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
1	152W00000X	Optometrist	0EG000922	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	PA07182	OTHER	VBA
2	PA15934	OTHER	QUALMED
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	195286	OTHER	JOHN HANCOCK
5	0235287000	OTHER	KEYSTONE
6	KE445341	OTHER	PA BLUE CROSS
7	32343	OTHER	DAVIS VISION
8	4408045	OTHER	AETNA PPO
9	459371	OTHER	US HEALTHCARE
10	U38207	OTHER	UPIN

General Provider Information

NPI Number	:	1386739399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J. KELLEHER OD

Provider Business Mailing Address
First Line	:	3238 RED LION RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1109
Country	:	US
Telephone Number	:	215-632-7378
Fax Number	:	215-632-1604

Provider Business Practice Location Address
First Line	:	3238 RED LION RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1109
Country	:	US
Telephone Number	:	215-632-7378
Fax Number	:	215-632-1604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/17/2024

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