Provider Demographics
NPI:1245275197
Name:DONLAN, KELLY M (OD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:DONLAN
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 1:135 MULONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055
Mailing Address - Country:US
Mailing Address - Phone:724-540-1771
Mailing Address - Fax:724-540-1773
Practice Address - Street 1:135 MULONE DRIVE
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055
Practice Address - Country:US
Practice Address - Phone:724-540-1771
Practice Address - Fax:724-540-1773
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist