Provider Demographics
NPI:1740832500
Name:CERCHIONE, KELLEY E (OD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:E
Last Name:CERCHIONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:ELIZABETH
Other - Last Name:SEDLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9701 VENTNOR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2222
Mailing Address - Country:US
Mailing Address - Phone:609-822-4242
Mailing Address - Fax:609-822-3211
Practice Address - Street 1:9701 VENTNOR AVE STE 201
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2222
Practice Address - Country:US
Practice Address - Phone:609-822-4242
Practice Address - Fax:609-822-3211
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00717500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300050052Medicaid
KY7100656280Medicaid