Basic Information
| Provider Information | |||||||||
| NPI: | 1316170988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 BOULEVARD ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303433311 | ||||||||
| FaxNumber: | 3303640951 | ||||||||
| Practice Location | |||||||||
| Address1: | 2104 GOLFVIEW DR NE | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446639700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437275 | ||||||||
| FaxNumber: | 3303437275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2009 | ||||||||
| LastUpdateDate: | 08/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 34-008270 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.