Provider Demographics
NPI:1558458125
Name:DUKE, KELLY FAUST JR (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:FAUST
Last Name:DUKE
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:2271 TOWN CENTER AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6108
Mailing Address - Country:US
Mailing Address - Phone:321-632-8356
Mailing Address - Fax:321-632-4449
Practice Address - Street 1:2271 TOWN CENTER AVE
Practice Address - Street 2:STE 101
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6108
Practice Address - Country:US
Practice Address - Phone:321-632-8356
Practice Address - Fax:321-632-4449
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-05-29
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Provider Licenses
StateLicense IDTaxonomies
FLOPC1406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist