Douglas Edward Kelley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3136-035 Issued in WI

Practice address

540 E Grand Ave
Beloit, WI 53511-6314

Phone

(608) 365-8575

Fax

(608) 362-2625

NPI assigned

May 19, 2008

Last updated

Jul 5, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Beloit Family Eye Care S.C.

  • Optometrist
  • Beloit, WI
  • NPI 1780976647
  Medicare reassignment NPD Authorized official
• Brodhead Vision Clinic, Inc

  dba Brodhead Vision

  • Optometrist
  • Brodhead, WI
  • NPI 1164416236
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467676800000",
    "number": "1033376090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 E GRAND AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116313",
            "telephone_number": "608-365-8575",
            "fax_number": "608-362-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E GRAND AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116314",
            "telephone_number": "608-365-8575",
            "fax_number": "608-362-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "DOUGLAS",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-19",
        "last_updated": "2016-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3136-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juli Karr, LPN
• Yusi Hezhao Kase, MD
• Carol J Katroscik, MSW LCSW
• Melissa Keesey
• Amy Kehl-White, PTA
• Makayla Kellner
• Leah Keyes, L.A.T., A.T.C.
• Yehia A. Khoga, MD
• Eric Haque Khondaker
• Kid's First Beloit (The Lincoln Academy)

• Optometrist in Beloit, WI
• Providers in Beloit, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.