Individual
KELLY WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
8084 RIVERS AVE STE 202, NORTH CHARLESTON, SC 29406-9235
(800) 485-9196
Mailing address
154 SWEET ALYSSUM DR, LADSON, SC 29456-3898
(773) 759-2679
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2211
AZ
152W00000X
Optometrist
Primary
2452
SC
Other
Enumeration date
07/05/2016
Last updated
06/07/2024
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