Provider Demographics
NPI:1619136421
Name:KELLIHER, KRISTOPHER ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:ALAN
Last Name:KELLIHER
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 1:2108 35TH AVE. SUITE A
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3955
Mailing Address - Country:US
Mailing Address - Phone:970-356-0100
Mailing Address - Fax:970-356-0101
Practice Address - Street 1:2108 35TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3955
Practice Address - Country:US
Practice Address - Phone:970-356-0100
Practice Address - Fax:970-356-0101
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT2641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist