Provider Demographics
NPI:1093979619
Name:HADNOT, KELLIE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:MARIE
Last Name:HADNOT
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 1:2829 GREAT NORTHERN LOOP
Mailing Address - Street 2:STE 100
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1752
Mailing Address - Country:US
Mailing Address - Phone:406-549-2541
Mailing Address - Fax:
Practice Address - Street 1:2106 OXFORD ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6638
Practice Address - Country:US
Practice Address - Phone:406-549-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT817152W00000X
OR3265ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist