Individual
KELLY PATRICK GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7437 BURNET RD, AUSTIN, TX 78757-2244
(512) 451-7562
(512) 451-7951
Mailing address
11801 SPRINGS HEAD LOOP, AUSTIN, TX 78717-4418
(512) 331-0211
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6702T
TX
152W00000X
Optometrist
T03284
MO
Other
Enumeration date
03/23/2006
Last updated
07/08/2007
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