Organization
COREY B. KELLY O.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREY B. KELLY O.D. (OPTOMETRIST)
(563) 582-5198
Entity
Organization
Contact information
Practice address
555 JOHN F KENNEDY RD, SUITE 665, DUBUQUE, IA 52002-5202
(563) 582-5198
(563) 582-5540
Mailing address
555 JOHN F KENNEDY RD, SUITE 665, DUBUQUE, IA 52002-5202
(563) 582-5198
(563) 582-5540
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2223
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720166945
INDIVIDUAL NPI
IA
01
—
I11205
MEDICARE GROUP NUMBER
IA
01
—
IA2223
EYEMED
IA
Enumeration date
12/04/2007
Last updated
12/04/2007
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