Provider Demographics
NPI:1811662414
Name:KELLY, CLAVEAR (LDO, ABOC, NCLEC)
Entity type:Individual
Prefix:MR
First Name:CLAVEAR
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 EMBRY DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4472
Mailing Address - Country:US
Mailing Address - Phone:404-333-9500
Mailing Address - Fax:
Practice Address - Street 1:3277 EMBRY DOWNS CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-4472
Practice Address - Country:US
Practice Address - Phone:404-333-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FC0800X, 156FC0801X
GALDO002174156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter