Individual
MR. KELLY MCCARTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4175 VINEWOOD LN N, PLYMOUTH, MN 55442-2624
(763) 553-2883
Mailing address
820 TOMAHAWK RD, NORTH PLATTE, NE 69101-6782
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1473
NE
152W00000X
Optometrist
Primary
3609
MN
Other
Enumeration date
06/09/2017
Last updated
08/10/2021
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