Charles Robert Kelly

Primary specialty

OpticianTaxonomy code 156FX1800X

License

TD3694 Issued in NJ

Practice address

Walmart Vision 979 Route 1 South
North Brunswick, NJ 08902-1902

Phone

(732) 545-0435

Fax

(732) 545-0629

NPI assigned

Jun 21, 2023

Last updated

Jun 21, 2023By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1687305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1376228742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "979 ROUTE 1",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089022712",
            "telephone_number": "732-545-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WALMART VISION 979 ROUTE 1 SOUTH",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089021902",
            "telephone_number": "732-545-0435",
            "fax_number": "732-545-0629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "979 Route 1",
            "address_purpose": "LOCATION",
            "city": "North Brunswick",
            "state": "NJ",
            "postal_code": "089022712",
            "country_code": "US",
            "telephone_number": "609-977-9620",
            "fax_number": "732-545-0629",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "994 Terrace Blvd",
            "address_purpose": "LOCATION",
            "city": "Ewing",
            "state": "NJ",
            "postal_code": "086181902",
            "country_code": "US",
            "telephone_number": "609-977-9620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHARLES",
        "middle_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NJ",
            "license": "TD3694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melvin I Katz
• Gurdeep Kaur
• Marc Christian Kay, DMD
• KC Medical Services, PC
• Virginia J Keil, LCSW
• Tanya Maria Kero, LCSW
• Hal Jordan Ketofsky, MA, LPC, LCADC
• Kathleen R Ketofsky, LCSW
• Kulsum Khan
• Anita Khanna, RPH

• Optician in North Brunswick, NJ
• Providers in North Brunswick, NJ by specialty
• Optician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.