Individual
BRENDAN S KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1234 WASHINGTON AVE STE A, DETROIT LAKES, MN 56501-3906
(218) 846-2258
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2604
CO
152W00000X
Optometrist
Primary
3999
MN
152W00000X
Optometrist
666
ND
Other
Enumeration date
07/13/2007
Last updated
05/27/2025
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