Provider Demographics
NPI:1881042943
Name:KELLY, JOSEPH DANIEL JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:110 GLANCY ST STE 208
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2313
Mailing Address - Country:US
Mailing Address - Phone:615-868-2877
Mailing Address - Fax:615-870-5771
Practice Address - Street 1:110 GLANCY ST STE 208
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2313
Practice Address - Country:US
Practice Address - Phone:615-868-2877
Practice Address - Fax:615-870-5771
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist