MEDICARE: CONRAD F. KELLY, O.D.,LLC

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	3058TG	TX

General Provider Information

NPI Number	:	1790022721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONRAD F. KELLY, O.D.,LLC

Provider Business Mailing Address
First Line	:	2352 SPERBER LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1553
Country	:	US
Telephone Number	:	713-450-4446
Fax Number	:	713-450-4864

Provider Business Practice Location Address
First Line	:	13750 I-10 EAST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-5929
Country	:	US
Telephone Number	:	713-450-4446
Fax Number	:	713-450-4864

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. CONRAD F. KELLY
Credential	:	OD
Telephone Number	:	713-450-4446

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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