Individual
KELLY NEIDIFFER BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4326 CHARLESTOWN RD, NEW ALBANY, IN 47150-9568
(812) 945-0023
(812) 945-0291
Mailing address
4326 CHARLESTOWN RD, NEW ALBANY, IN 47150-9568
(812) 945-0023
(812) 945-0291
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1594 DT
KY
152W00000X
Optometrist
Primary
18003232A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350868
ANTHEM BCBS
IN
01
—
1594DT
OD LICENSE NUMBER
KY
01
—
18003232A
OD LICENSE NUMBER
IN
05
—
200470620
—
IN
01
—
P00191799
RR MEDICARE
IN
Enumeration date
08/16/2005
Last updated
09/25/2012
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