# OPHTHALMOLOGY & OCULOPLASTIC SURGERY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kellis Eye and Laser Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073713400
- **Authorized official:** CANDICE DAVIS (CHIEF REVENUE CYCLE OFFICER)
- **Authorized official phone:** (916) 990-7590

## Contact information

- **Practice address:** 150 7TH AVE, SUITE 100, CHARDON, OH 44024-2908
- **Practice address phone:** (440) 285-2020
- **Practice address fax:** (440) 285-8448
- **Mailing address:** 150 7TH AVE STE 100, CHARDON, OH 44024-2909
- **Mailing address phone:** (440) 285-2020
- **Mailing address fax:** (440) 285-8448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 5012T188 | OH | — |
| 207W00000X | Ophthalmology Physician | 35060480 | OH | Yes |

## Other

- **Enumeration date:** 07/24/2007
- **Last updated:** 06/09/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2841689 | — | OH |
| 01 | — | CG4745 | RAILROAD MEDICARE | OH |