Provider Demographics
NPI:1831133057
Name:AYERS, KELLE (OD)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLE
Other - Middle Name:
Other - Last Name:AYERS-RAPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:236 ROSEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-859-4311
Mailing Address - Fax:908-859-4499
Practice Address - Street 1:236 ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865
Practice Address - Country:US
Practice Address - Phone:908-859-4311
Practice Address - Fax:908-859-4499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00511500152W00000X
NJ27T000048100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02K0440OtherHEALTHNET
2163713OtherAETNA
761842OtherHIGHMARK
2163713OtherAETNA
U19817Medicare UPIN