MEDICARE: KELLY C. KAO, O.D., A PROFESSIONAL CORPORATION

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	152WP0200X	Pediatric Optometrist	13772	CA
2	152WS0006X	Sports Vision Optometrist	13772	CA
3	152WV0400X	Vision Therapy Optometrist	13772	CA
4	152W00000X	Optometrist	13772	CA

General Provider Information

NPI Number	:	1801335542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY C. KAO, O.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1580 W EL CAMINO REAL STE 6
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2462
Country	:	US
Telephone Number	:	650-695-5917
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 W EL CAMINO REAL STE 6
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2462
Country	:	US
Telephone Number	:	650-695-5917
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELLY KAO
Credential	:	OD
Telephone Number	:	408-396-7179

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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