Individual
KELLY HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
131 W GYPSY LANE RD, BOWLING GREEN, OH 43402-4503
(419) 352-6505
Mailing address
131 W GYPSY LANE RD, BOWLING GREEN, OH 43402-4503
(419) 352-6505
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OP.017337-S
OH
Other
Enumeration date
03/02/2023
Last updated
03/02/2023
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