Individual
WAYNE J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1649 NORTHERN BLVD, MANHASSET, NY 11030-3026
(516) 365-4066
Mailing address
1649 NORTHERN BLVD, MANHASSET, NY 11030-3026
(516) 365-4066
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
005159-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02604960
—
NY
01
—
1002050000
UFT
NY
01
—
18046
DAVIS VISION
NY
01
—
837
VISION SCREENING
NY
01
—
NY5159
EYEMED
NY
Enumeration date
09/23/2006
Last updated
02/12/2009
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