Provider Demographics
NPI:1568720415
Name:KELLI MCCARTNEY O.D. PC
Entity Type:Organization
Organization Name:KELLI MCCARTNEY O.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-444-5573
Mailing Address - Street 1:1476 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2355
Mailing Address - Country:US
Mailing Address - Phone:304-444-5573
Mailing Address - Fax:
Practice Address - Street 1:1476 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2355
Practice Address - Country:US
Practice Address - Phone:304-444-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1077-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty