Provider Demographics
NPI:1255711644
Name:STEELE, KELLY BAIN (OD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BAIN
Last Name:STEELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:BASSETT ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:1060 GAFFNEY RD #7440
Mailing Address - City:FT. WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703
Mailing Address - Country:US
Mailing Address - Phone:907-361-5603
Mailing Address - Fax:907-361-4847
Practice Address - Street 1:510 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3105
Practice Address - Country:US
Practice Address - Phone:706-863-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist