Individual
KAILEY UTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8010 OAK PARK RD NE, NEW SALISBURY, IN 47161-8401
(812) 366-3147
Mailing address
11362 BURGESS AVE, BRIDGETON, MO 63044-3102
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18004367A
IN
152W00000X
Optometrist
2020015887
MO
152W00000X
Optometrist
Primary
2374DT
KY
Other
Enumeration date
05/19/2020
Last updated
06/28/2024
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