Provider Demographics
NPI:1073777637
Name:O'SHEA, KELLY (OD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8021
Mailing Address - Country:US
Mailing Address - Phone:559-737-9690
Mailing Address - Fax:559-737-9699
Practice Address - Street 1:3746 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8021
Practice Address - Country:US
Practice Address - Phone:559-737-9690
Practice Address - Fax:559-737-9699
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002116152W00000X
CAOPT 13800 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist