Individual
KELLY VAN CLEAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2801 E 29TH ST, BRYAN, TX 77802-2618
(979) 776-7564
Mailing address
2801 E 29TH ST, BRYAN, TX 77802-2618
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8944T
TX
Other
Enumeration date
08/02/2016
Last updated
07/30/2020
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