Provider Demographics
NPI:1396838314
Name:KELLY, NORWOOD R JR (OD)
Entity Type:Individual
Prefix:
First Name:NORWOOD
Middle Name:R
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:242 SARAH VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-4146
Mailing Address - Country:US
Mailing Address - Phone:504-452-0390
Mailing Address - Fax:504-656-7158
Practice Address - Street 1:2010 WOODMERE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2286
Practice Address - Country:US
Practice Address - Phone:504-371-8044
Practice Address - Fax:504-371-8042
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY2316DT152W00000X
MDDA2924152W00000X
SC1395152W00000X
DEI5-0000002152W00000X
PAOET009163152W00000X
LA939165T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist