Provider Demographics
NPI:1093011868
Name:PALMER, JAMES KELLY III (LDO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KELLY
Last Name:PALMER
Suffix:III
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1960
Mailing Address - Country:US
Mailing Address - Phone:937-270-2425
Mailing Address - Fax:
Practice Address - Street 1:765 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1960
Practice Address - Country:US
Practice Address - Phone:937-270-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5845-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician