Active NPI
Dawn Aileen Kelly, O.D.
- Optometrist
- Parker, AZ
National Provider Identifier
1033216718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 453/ T2453
- Practice address
- 12033 Agency Rd
Parker, AZ 85344-7718 - Phone
- (928) 669-3289
- Fax
- (928) 669-3200
- NPI assigned
- Sep 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2130 | OK | |
| Optometrist | 152W00000X | 453/ T2453 | NM | Primary |
Addresses
Primary practice location
12033 Agency Rd
Parker, AZ 85344-7718
Mailing address
10696 Fenton Dr
Parker, AZ 85344-7503
Phone (928) 667-4682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 453/ T2453 | NM | MD | Optometrist |
| 453 | NM | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1033216718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10696 FENTON DR",
"city": "PARKER",
"state": "AZ",
"postal_code": "853447503",
"telephone_number": "928-667-4682",
"fax_number": "928-669-3200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12033 AGENCY RD",
"city": "PARKER",
"state": "AZ",
"postal_code": "853447718",
"telephone_number": "928-669-3289",
"fax_number": "928-669-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "DAWN",
"middle_name": "AILEEN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-17",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "2130",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NM",
"license": "453/ T2453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parker, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.