Individual
MR. KELLY E GODSEY II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
111 BROYLES ST, JOHNSON CITY, TN 37601-2532
(423) 282-1932
(423) 282-8813
Mailing address
111 BROYLES ST, JOHNSON CITY, TN 37601-2532
(423) 282-1932
(423) 282-8813
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DPO174
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0188636
—
TN
Enumeration date
09/16/2006
Last updated
01/11/2008
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