Provider Demographics
NPI:1821653791
Name:KELLEY, KEYANA (OD)
Entity Type:Individual
Prefix:
First Name:KEYANA
Middle Name:
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 1:2840 STELZER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3133
Mailing Address - Country:US
Mailing Address - Phone:614-756-0091
Mailing Address - Fax:614-756-0092
Practice Address - Street 1:2840 STELZER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3133
Practice Address - Country:US
Practice Address - Phone:614-756-0091
Practice Address - Fax:614-756-0092
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist