Provider Demographics
NPI:1023018611
Name:KELL, HALE MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:HALE
Middle Name:MATTHEW
Last Name:KELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SUMMIT VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-665-7797
Mailing Address - Fax:303-673-9578
Practice Address - Street 1:1220 SUMMIT VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-665-7797
Practice Address - Fax:303-673-9578
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08014706Medicaid
CO08014706Medicaid
COCA0813Medicare PIN