Provider Demographics
NPI:1558713859
Name:KELLY FAMILY EYECARE, LLC
Entity Type:Organization
Organization Name:KELLY FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-870-5822
Mailing Address - Street 1:458 TALCOTTVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4052
Mailing Address - Country:US
Mailing Address - Phone:860-870-5822
Mailing Address - Fax:
Practice Address - Street 1:458 TALCOTTVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4052
Practice Address - Country:US
Practice Address - Phone:860-870-5822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty