Provider Demographics
NPI:1578525721
Name:MCKELVEY, JAMES G (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:4110 MAPLE RD
Practice Address - Street 2:EMPIRE VISION CENTERS MAPLE CROSSING STE 400
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-831-8050
Practice Address - Fax:716-831-8053
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0069961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9707Medicare PIN
U88134Medicare UPIN
NYRA9705Medicare PIN
NYRA9704Medicare PIN
NYRA9706Medicare PIN