Provider Demographics
NPI:1679095608
Name:PEREIRA, KELLY M (OD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:OD
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Other - First Name:
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Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-431-1119
Mailing Address - Fax:401-943-1324
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-431-1119
Practice Address - Fax:401-431-1125
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIODTG00643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist