Individual
DR. ROBERT MOULEDOUX KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4225 LAPALCO BLVD., MARRERO, LA 70072-4338
(504) 371-9355
(480) 503-3943
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
(480) 503-3943
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1063-495T
AZ
152W00000X
Optometrist
Primary
1276-434T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04426013
—
MS
01
—
167609
EYEMED PROVIDER ID
AZ
05
—
2120301
—
LA
Enumeration date
08/14/2006
Last updated
12/06/2010
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