Individual
DR. MAGGIE LS KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2609
CO
152W00000X
Optometrist
Primary
665
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467405928
GROUP NPI
CO
01
—
1497944615
ANTHEM BS
CO
01
—
C806738
MEDICARE GROUP ID
CO
Enumeration date
10/24/2007
Last updated
08/01/2014
Update your record
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