Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
N | 156FC0801X | Contact Lens Fitter | ||
Y | 156FX1800X | Optician | LDO002174 | GA |
NPI | 1811662414 |
---|---|
Provider Name | Clavear Kelly |
First Address | Atlanta, GA 30340-4472 |
Second Address | Atlanta, GA 30340-4472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 16/08/2021 |