Corey B. Kelly O.D.P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2223 Issued in IA

Legal business name

COREY B. KELLY O.D.P.C.

Practice address

555 John F Kennedy Rd
Suite 665
Dubuque, IA 52002-5202

Phone

(563) 582-5198

Fax

(563) 582-5540

NPI assigned

Dec 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Corey B. Kelly, O.D.

Title

Optometrist

Phone

(563) 582-5198

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1386826097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 JOHN F KENNEDY RD",
            "address_2": "SUITE 665",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520025202",
            "telephone_number": "563-582-5198",
            "fax_number": "563-582-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 JOHN F KENNEDY RD",
            "address_2": "SUITE 665",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520025202",
            "telephone_number": "563-582-5198",
            "fax_number": "563-582-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREY B. KELLY O.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "563-582-5198",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "2223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "I11205",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1720166945",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "IA2223",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amy Cordingley, RD, LD
• Richard Corfman, LISW
• Cornerstone Caregiving East LLC
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• Carolyn Cornish, DC
• County of Dubuque

• Optometrist in Dubuque, IA
• Providers in Dubuque, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.