Individual
DR. IAIN M KELLY SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3100 GOVERNORS PLACE BLVD, KETTERING, OH 45409-1334
(937) 297-7676
Mailing address
PO BOX 33, MEDWAY, OH 45341-0033
(937) 776-4788
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4207
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000330236
ANTHEM
OH
Enumeration date
07/08/2006
Last updated
09/21/2021
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