Provider Demographics
NPI:1669587143
Name:BISHOP, KELLI (OD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BISHOP
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 1:907 BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3905
Mailing Address - Country:US
Mailing Address - Phone:940-521-8552
Mailing Address - Fax:
Practice Address - Street 1:1529 380 BYP
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-2323
Practice Address - Country:US
Practice Address - Phone:940-549-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1683DT152W00000X
TX8043T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist