Provider Demographics
NPI:1780953364
Name:HAGOOD, KELLY CONYER (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CONYER
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:CONYER
Other - Last Name:DOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2011 N ROAN ST
Mailing Address - Street 2:DR. CARLSON & ASSOCIATES IN THE MALL AT JOHNSON CITY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3130
Mailing Address - Country:US
Mailing Address - Phone:423-610-7155
Mailing Address - Fax:
Practice Address - Street 1:2306 KNOB CREEK RD STE 106
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2366
Practice Address - Country:US
Practice Address - Phone:423-929-2020
Practice Address - Fax:423-929-3140
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002994152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist