NPIMap

Organization Active NPI

Kelly Optometry, a Professional Corporation

  • Optometrist
  • Denham Springs, LA
National Provider Identifier
1104748169
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KELLY OPTOMETRY, A PROFESSIONAL CORPORATION
Practice address
201 Bass Pro Blvd
Denham Springs, LA 70726-5570
Phone
(225) 665-2887
NPI assigned
Jul 29, 2026
Organization subpart
Yes
Parent organization
KELLY OPTOMETRY, A PROFESSIONAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Authorized official

Name
Susan L Christopher-Brand
Title
Credentialing Manager
Phone
(703) 314-8795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

201 Bass Pro Blvd
Denham Springs, LA 70726-5570

Mailing address

1 Vermont Dr
New Hyde Park, NY 11042-1128

National Provider Directory

National Provider Directory
Tax ID family
Kelly Optometry a Professional Corporation11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 Bass Pro Blvd
Denham Springs, LA 70726
Phone (225) 665-2887

NPI Registry JSON

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

{
    "created_epoch": "1785283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1104748169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VERMONT DR",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BASS PRO BLVD",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707265570",
            "telephone_number": "225-665-2887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY OPTOMETRY, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KELLY OPTOMETRY, A PROFESSIONAL CORPORATION",
        "enumeration_date": "2026-07-29",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "CHRISTOPHER-BRAND",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "703-314-8795"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denham Springs, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.