Active NPI
Michael R Kelly
- Optician
- Vernon, CT
National Provider Identifier
1043693468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 000733
- Practice address
- 458 Talcottville Rd
Vernon, CT 06066-4052 - Phone
- (860) 875-6156
- Fax
- (860) 872-3828
- NPI assigned
- Jul 2, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 000733 | CT | Primary |
Addresses
Primary practice location
458 Talcottville Rd
Vernon, CT 06066-4052
Mailing address
458 Talcottville Rd
Vernon, CT 06066-4052
Phone (860) 875-6156
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000733 | CT | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelly Family Eyecare, LLC | Past | Accepting new patients | |
| Eyeball Optical Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Eyewear Supplier
- Vernon, CT
- NPI 1932296225
-
- Optometrist
- Vernon, CT
- NPI 1558713859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435795200000",
"number": "1043693468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "458 TALCOTTVILLE RD",
"city": "VERNON",
"state": "CT",
"postal_code": "060664052",
"telephone_number": "860-875-6156",
"fax_number": "860-872-3828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "458 TALCOTTVILLE RD",
"city": "VERNON",
"state": "CT",
"postal_code": "060664052",
"telephone_number": "860-875-6156",
"fax_number": "860-872-3828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MICHAEL",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-02",
"last_updated": "2015-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CT",
"license": "000733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vernon, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.