Thomas M Kelly, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3675 T836 Issued in OH

Practice address

570 Dover Center Rd
Bay Village, OH 44140-2361

Phone

(440) 871-1139

Fax

(440) 871-0222

NPI assigned

Sep 16, 2006

Last updated

Oct 1, 2014By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thomas Kelly OD IncGroup PAC ID 4880947738, 4 clinicians

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.

• Thomas Kelly OD Inc

  • Optometrist
  • Bay Village, OH
  • NPI 1982093746
  Medicare reassignment Care Compare group NPD Authorized official
• Thomas M. Kelly O.D., Inc.

  • Eyewear Supplier
  • Bay Village, OH
  • NPI 1528222668
  NPD Authorized official

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412121600000",
    "number": "1285730986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441402357",
            "telephone_number": "440-871-1139",
            "fax_number": "440-871-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441402361",
            "telephone_number": "440-871-1139",
            "fax_number": "440-871-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "THOMAS",
        "middle_name": "M",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2014-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3675 T836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0528094",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Keane
• Donna Keller, RPH
• Dennis Michael Kelley, RN NP
• Emily Kelley
• Sarah Margaret Kelley
• Kenna R Mycek
• Huma Khatri, PHARMD
• Helen Kosko, RN
• Taylor Kovacich, RBT
• Alyssa Kraus

• Optometrist in Bay Village, OH
• Providers in Bay Village, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.