Provider Demographics
NPI:1598740367
Name:TRUSTY, KELBY ATKINS (OD)
Entity Type:Individual
Prefix:DR
First Name:KELBY
Middle Name:ATKINS
Last Name:TRUSTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 UNICORN LAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0118
Mailing Address - Country:US
Mailing Address - Phone:940-891-3937
Mailing Address - Fax:940-591-8368
Practice Address - Street 1:3111 UNICORN LAKE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0117
Practice Address - Country:US
Practice Address - Phone:940-891-3937
Practice Address - Fax:940-591-8368
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3995TG152WC0802X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3995TGOtherOD LICENSE NUMBER
TX0178390001OtherMEDICARE - PALMETTO DME
TX019328601Medicaid
TX80236QOtherBCBS
TX81027EMedicare PIN
TX80236QOtherBCBS