Provider Demographics
NPI:1881982163
Name:MAHAJERI KELLY, SOGOL (OD)
Entity type:Individual
Prefix:DR
First Name:SOGOL
Middle Name:
Last Name:MAHAJERI KELLY
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 1:7800 E HAMPDEN AVE UNIT 51
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4862
Mailing Address - Country:US
Mailing Address - Phone:303-755-9880
Mailing Address - Fax:303-338-5994
Practice Address - Street 1:7800 E HAMPDEN AVE UNIT 51
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4862
Practice Address - Country:US
Practice Address - Phone:303-755-9880
Practice Address - Fax:303-338-5994
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist