Kelly Keane OD Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

15197 Issued in CA

Legal business name

KELLY KEANE OD PROFESSIONAL CORPORATION

Practice address

5680 Balboa Ave
San Diego, CA 92111-2706

Phone

(858) 278-2837

NPI assigned

Aug 9, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Keane, ODNPI 1326480476

Title

Optometrist

Phone

(973) 557-5521

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly M. Keane, O.D.

  • Optometrist
  • San Diego, CA
  • NPI 1326480476
  Medicare reassignment NPD Authorized official
• Melody Deborah Tavakoli, O.D.

  • Optometrist
  • San Diego, CA
  • NPI 1154623254
  NPD (past)
• Thuy-Diem Ngo Tran, O.D.

  • Optometrist
  • San Diego, CA
  • NPI 1861701385
  NPD (past)

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627084800000",
    "number": "1194240358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4203 GENESEE AVE SUITE 103",
            "address_2": "#436",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921175071",
            "telephone_number": "973-557-5521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 BALBOA AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112706",
            "telephone_number": "858-278-2837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY KEANE OD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-09",
        "last_updated": "2021-07-24",
        "certification_date": "2021-07-24",
        "status": "A",
        "authorized_official_last_name": "KEANE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "973-557-5521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorena Kellogg
• Marlyn Kellogg
• Shannon Marie Kellogg, MA
• Sopahn Kellogg
• Kelly J Hwang DDS Inc
• Kelly L. Lange Psychology, a Professional Corporation
• Kelly S Keefe MD Inc
• Kyelunye Kelly-Adegbola
• Martha Kelly-Luken
• Adrienne M. Kelly, MD

• Optometrist in San Diego, CA
• Providers in San Diego, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.