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Individual
DR. ROBERT MOULEDOUX KELLY
Active
Individual
DR. ROBERT MOULEDOUX KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1063-495T
AZ
152W00000X
Optometrist
Primary
1276-434T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04426013
—
MS
01
—
167609
EYEMED PROVIDER ID
AZ
05
—
2120301
—
LA
Enumeration date
08/14/2006
Last updated
12/06/2010
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