Active NPI
Kelly Ly, O.D
- Optometrist
- Bakersfield, CA
National Provider Identifier
1447603394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 33813
- Practice address
- 3800 Rosedale Hwy
Bakersfield, CA 93308-6235 - Phone
- (714) 902-4996
- NPI assigned
- Jul 15, 2016
- Last updated
- Nov 22, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2114 | AZ | |
| Optometrist | 152W00000X | 33813 | CA | Primary |
Addresses
Primary practice location
3800 Rosedale Hwy
Bakersfield, CA 93308-6235
Mailing address
9110 Sonoma Way
Bakersfield, CA 93312-4339
Phone (714) 902-4996
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163868 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kvision Ly Inc | Optometrist | Current | Accepting new patients |
Locations
3800 Rosedale Hwy
Bakersfield, CA 93308
Phone (661) 852-2642
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669075200000",
"number": "1447603394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9110 SONOMA WAY",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933124339",
"telephone_number": "714-902-4996",
"fax_number": "480-893-8172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 ROSEDALE HWY",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933086235",
"telephone_number": "714-902-4996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "KELLY",
"credential": "O.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-15",
"last_updated": "2022-11-22",
"certification_date": "2022-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "2114",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "33813",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "163868",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
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- Luxy Transportation LLC
- Michelle Ly
- Clara R Lyashevsky, DO
- Emily Rose Lyles, LCSW
- Elizabeth Ashley Lyman
- Anna Margaret Lynch
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.