Individual
DR. KELLY JACOBI WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2305 OLEANDER AVE., FORT PIERCE, FL 34982
(772) 465-6616
(772) 468-2858
Mailing address
2305 OLEANDER AVE., FORT PIERCE, FL 34982
(772) 465-6616
(772) 468-2858
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC4270
FL
Other
Enumeration date
09/10/2007
Last updated
07/27/2009
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