Provider Demographics
NPI:1639424633
Name:MAKLEY, KELLY JO (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JO
Last Name:MAKLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:ZINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2203 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2928
Mailing Address - Country:US
Mailing Address - Phone:937-525-9266
Mailing Address - Fax:937-525-9633
Practice Address - Street 1:1475 UPPER VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4047
Practice Address - Country:US
Practice Address - Phone:937-525-9266
Practice Address - Fax:937-525-9633
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist