Individual
MICHAEL GERARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1578 HIGHWAY 44 E, STE 7, SHEPHERDSVILLE, KY 40165-7172
(502) 543-0646
(502) 543-0648
Mailing address
1578 HIGHWAY 44 E, STE 7, SHEPHERDSVILLE, KY 40165-7172
(502) 543-0646
(502) 897-6599
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1173 DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77011732
—
KY
Enumeration date
07/07/2006
Last updated
01/14/2010
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