Provider Demographics
NPI:1932497690
Name:BUGG, KELLY SMILEY (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SMILEY
Last Name:BUGG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JAHN
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 PARIS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2742
Mailing Address - Country:US
Mailing Address - Phone:270-247-5532
Mailing Address - Fax:270-247-0245
Practice Address - Street 1:813 PARIS RD
Practice Address - Street 2:SUITE B
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2742
Practice Address - Country:US
Practice Address - Phone:270-247-5532
Practice Address - Fax:270-247-0258
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1864DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100170490Medicaid
KY6716800001Medicare NSC