Provider Demographics
NPI:1548241318
Name:VU, KELLY T (OD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:T
Last Name:VU
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 1:6062 S TELLURIDE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3202
Mailing Address - Country:US
Mailing Address - Phone:303-796-8227
Mailing Address - Fax:
Practice Address - Street 1:7805 E 35TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2458
Practice Address - Country:US
Practice Address - Phone:720-941-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO460658Medicare ID - Type Unspecified
U65073Medicare UPIN