Individual
KELLY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2911 53RD AVE E, BRADENTON, FL 34203-4312
(941) 752-0802
Mailing address
11542 MIDDLE FORK WAY, PARRISH, FL 34219
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO5600
FL
Other
Enumeration date
09/04/2023
Last updated
09/04/2023
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