Iain M Kelly Sr., OD
Individual provider Active NPI Optometrist · Kettering, OH
NPI 1366475014 · NPPES record last updated Sep 21, 2021
Key facts
- NPI
- 1366475014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4207 (OH)
- Practice address
- 3100 Governors Place Blvd
Kettering, OH 45409-1334 - Phone
- (937) 297-7676
- NPI assigned
- Jul 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Warwar Eye Group Inc
Practice addresses (Care Compare)
3100 Governors Place Blvd
Kettering, OH 45409-1334
Phone (937) 297-7676
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040730001082 | OH | Practitioner - Optometry | 0143290577 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4207 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Warwar Eye Group, Inc | Optometrist | Current |
Accepting new patients |
| Ernst F. Fischer O.D., Inc. | Optometrist | Past | Accepting new patients |
| Todd McManus OD & Assoc Inc | Optometrist | Past | Accepting new patients |
| Warwar Eye Group | Past | Accepting new patients |
Locations
3100 Governors Place Blvd
Ste 100
Kettering, OH 45409
Phone (937) 297-7676
3100 Governors Place Blvd
Kettering, OH 45409
Phone (937) 297-7676
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4207 | OH | Yes |
Addresses
Primary practice location
3100 Governors Place Blvd
Kettering, OH 45409-1334
Mailing address
PO Box 33
Medway, OH 45341-0033
Phone (937) 776-4788
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000330236 | Other | OH | ANTHEM |
Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.