Provider Demographics
NPI:1265091326
Name:REED, KELLY ANNE (OD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:REED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2111 E HIGHLAND AVE STE B240
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4741
Mailing Address - Country:US
Mailing Address - Phone:480-994-5012
Mailing Address - Fax:480-994-9479
Practice Address - Street 1:7245 E OSBORN RD STE 4
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6443
Practice Address - Country:US
Practice Address - Phone:480-994-5012
Practice Address - Fax:480-994-9479
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1020152W00000X
AZOPT-002468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist