Provider Demographics
NPI:1710395769
Name:KELLEY, SARAH LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LEIGH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3311
Mailing Address - Country:US
Mailing Address - Phone:620-331-9090
Mailing Address - Fax:620-331-0011
Practice Address - Street 1:115 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3311
Practice Address - Country:US
Practice Address - Phone:620-331-9090
Practice Address - Fax:620-331-0011
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist