Individual
DR. KELLY LYNNE CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
219 E WASHINGTON ST, MARTINSVILLE, IN 46151-1554
(765) 342-6654
(765) 342-0418
Mailing address
219 E WASHINGTON ST, MARTINSVILLE, IN 46151-1554
(765) 342-6654
(765) 342-0418
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003161B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679673495
GROUP NPI
IN
05
—
200341850A
—
IN
Enumeration date
07/15/2005
Last updated
10/01/2008
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