Individual
DR. KELLY JOHN CORBRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2187 AIRWAY AVE., KINGMAN, AZ 86409-3669
(928) 757-5005
Mailing address
2187 AIRWAY AVE., KINGMAN, AZ 86409-3669
(928) 757-5005
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
829
AZ
Other
Enumeration date
08/13/2007
Last updated
05/12/2008
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