Malcolm H. Kelly Jr., OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG000335 Issued in PA

Practice address

49 S 2ND St
Oxford, PA 19363-1370

Phone

(610) 932-9356

Fax

(610) 932-3097

NPI assigned

Jun 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Oxford Family Eyecare, PC

  • Optometrist
  • Oxford, PA
  • NPI 1861447880
  Authorized official Same address or phone

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1356388060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 S 2ND ST",
            "city": "OXFORD",
            "state": "PA",
            "postal_code": "193631370",
            "telephone_number": "610-932-9356",
            "fax_number": "610-932-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MALCOLM",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - GROUP MEDICARE NO.",
            "identifier": "091164",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA STATE LICENSE NO.",
            "identifier": "OEG000335",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC JURISDICTION A",
            "identifier": "5426540001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• KC Grouphome.LLC
• Sarah Lynn Keiser, CRNP
• Naby M Keita, RPH
• Jennifer Marie Kelleher, DPT
• Lisa Jean Kelly, PTA
• Marilyn Adele Knaub, M.D.
• Kristen G. Koechert, FNP
• Holly Kozlik, OTR/L
• Lancaster General Medical Group (Penn Medicine LGHP Family Medicine Oxford)
• LCH Health and Community Services

• Optometrist in Oxford, PA
• Providers in Oxford, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.