Individual
DR. KELLY LOUISE CYR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2820
CO
152W00000X
Optometrist
619
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053542530
NATIONAL PROVIDER ID NUMBER
NM
05
—
84983361
—
NM
05
—
9000165068
—
CO
01
—
P00910104
MEDICARE RAILROAD CARRIER
NM
Enumeration date
08/02/2009
Last updated
01/23/2024
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