Individual
DR. KYLE W KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2301 10TH AVE, LEAVENWORTH, KS 66048-4214
(913) 682-2929
(913) 682-2999
Mailing address
2301 10TH AVE, LEAVENWORTH, KS 66048-4214
(913) 682-2929
(913) 682-2999
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1309-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002187108
—
KS
Enumeration date
08/09/2005
Last updated
07/08/2007
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