Provider Demographics
NPI:1831237882
Name:RAIES, KELLY (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:RAIES
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 1:1915 SCIOTO TRL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2843
Mailing Address - Country:US
Mailing Address - Phone:740-354-2821
Mailing Address - Fax:740-354-6162
Practice Address - Street 1:1915 SCIOTO TRL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2843
Practice Address - Country:US
Practice Address - Phone:740-354-2821
Practice Address - Fax:740-354-6162
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist