Individual
LAURA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1495 W SR 434, LONGWOOD, FL 32750-3861
(407) 332-8255
Mailing address
1600 ALDEN RD APT 640, ORLANDO, FL 32803-1976
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC6171
FL
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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