MEDICARE: MR. KELLY E GODSEY II OPTICIAN

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	156FX1800X	Optician	DPO174	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952407827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELLY E GODSEY II OPTICIAN

Provider Business Mailing Address
First Line	:	111 BROYLES ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2532
Country	:	US
Telephone Number	:	423-282-1932
Fax Number	:	423-282-8813

Provider Business Practice Location Address
First Line	:	111 BROYLES ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2532
Country	:	US
Telephone Number	:	423-282-1932
Fax Number	:	423-282-8813

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/11/2008

Similar Medicare Providers

1982622601 — SHANNON WADE MYERS D.C.
Practice Location Address:

111 BROYLES ST , SUITE 6
JOHNSON CITY, TN
37601-2532

Practice Phone: 423-610-0005
Practice Fax: 423-610-0009

1033383310 — GODSEY ENTERPRISES INC
Practice Location Address:

111 BROYLES ST
JOHNSON CITY, TN
37601-2532

Practice Phone: 423-282-1932
Practice Fax: 423-282-8813

1407012495 — SHANNON MYERS DC LLC
Practice Location Address:

111 BROYLES ST , SUITE 6
JOHNSON CITY, TN
37601-2532

Practice Phone: 423-610-0005
Practice Fax: 423-610-0009

1982836722 — DR. TALINE ANNIE KOTCHOUNIAN DDS
Practice Location Address:

12265 VENTURA BLVD STE 208
STUDIO CITY, CA
91604-2532

Practice Phone: 818-538-8899
Practice Fax:

1336455294 — MRS. AUDRIE ROSE MOUZAKIS RN
Practice Location Address:

1400 HUNTERS RIDGE DR , UNIT 63
GENOA CITY, WI
53128-2532

Practice Phone: 262-215-9691
Practice Fax:

1467882977 — DR. RON IAN MALCOLM ED.D.
Practice Location Address:

2532 N 107TH ST
KANSAS CITY, KS
66109-3630

Practice Phone: 913-306-6027
Practice Fax: 913-727-1602

Directions to “ MR. KELLY E GODSEY II OPTICIAN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.