NPIMap

Organization Active NPI

Thomas M. Kelly O.D., Inc.

  • Eyewear Supplier
  • Bay Village, OH
National Provider Identifier
1528222668
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
3675 Issued in OH
Legal business name
THOMAS M. KELLY O.D., INC.
Practice address
Thomas M Kelly OD Inc.
433 Dover Center Rd
Bay Village, OH 44140-2357
Phone
(440) 871-1139
Fax
(440) 871-0222
NPI assigned
Jul 17, 2008
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Dr. Thomas Milo Kelly, O. D.NPI 1285730986
Title
Optometrist
Phone
(440) 871-1139

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 3675 OH
Eyewear Supplier 332H00000X 3675 OH Primary

Addresses

Primary practice location

Thomas M Kelly OD Inc.
433 Dover Center Rd
Bay Village, OH 44140-2357

Mailing address

457 Dover Center Rd
Bay Village, OH 44140-2357
Phone (440) 871-1139

Other identifiers 1

IdentifierTypeStateIssuer
0528094MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Thomas Kelly OD Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

433 Dover Center Rd
Bay Village, OH 44140
Phone (440) 871-1139

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1528222668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441402357",
            "telephone_number": "440-871-1139",
            "fax_number": "440-871-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THOMAS M KELLY OD INC.",
            "address_2": "433 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441402357",
            "telephone_number": "440-871-1139",
            "fax_number": "440-871-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS M. KELLY O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-17",
        "last_updated": "2024-11-05",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MILO",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "440-871-1139",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O. D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OH",
            "license": "3675",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "OH",
            "license": "3675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0528094",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Village, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; 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.