Provider Demographics
NPI:1265607675
Name:DR.NORWOOD R. KELLY JR.APOC
Entity type:Organization
Organization Name:DR.NORWOOD R. KELLY JR.APOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORWOOD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:504-452-0390
Mailing Address - Street 1:242 SARAH VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-4146
Mailing Address - Country:US
Mailing Address - Phone:504-452-0390
Mailing Address - Fax:
Practice Address - Street 1:2010 WOODMERE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2286
Practice Address - Country:US
Practice Address - Phone:504-452-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA939-165T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty