Basic Information
Provider Information | |||||||||
NPI: | 1235385766 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DYER | ||||||||
FirstName: | KELLI | ||||||||
MiddleName: | HERLIHY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HERLIHY | ||||||||
OtherFirstName: | KELLI | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6600 S YALE AVE STE 1200 | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741363333 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9184886653 | ||||||||
FaxNumber: | 9184886098 | ||||||||
Practice Location | |||||||||
Address1: | 6465 S YALE AVE STE 301 | ||||||||
Address2: |   | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741367823 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9185023500 | ||||||||
FaxNumber: | 9185023505 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/15/2008 | ||||||||
LastUpdateDate: | 05/10/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/10/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 5101017831 | MI | N |   | Allopathic & Osteopathic Physicians | Ophthalmology |   | 207W00000X | 5477 | OK | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
No ID Information.