Individual
DR. JAMES MICHAEL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
489 TAFT AVE STE 100, GLEN ELLYN, IL 60137-8209
(630) 790-1300
(630) 790-1378
Mailing address
489 TAFT AVE STE 100, GLEN ELLYN, IL 60137-8209
(630) 790-1300
(630) 790-1378
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008415
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2232411
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/05/2006
Last updated
01/13/2015
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