Organization
ROBERT W. KELLEY ODPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT W KELLEY (PRESIDENT)
(406) 827-4327
Entity
Organization
Contact information
Practice address
401 MAIN STREET, THOMPSON FALLS, MT 59873-0399
(406) 827-4327
(406) 827-3027
Mailing address
PO BOX 399, THOMPSON FALLS, MT 59873-0399
(406) 827-4327
(406) 827-3027
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
349
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048-3119
—
MT
01
—
0642010001
DME MEDICARE
MT
01
—
26620
BLUE CROSS/BLUE SHIELD MT
MT
Enumeration date
09/28/2006
Last updated
02/01/2008
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