Robert W. Kelley Odpc

Primary specialty

OptometristTaxonomy code 152W00000X

License

349 Issued in MT

Legal business name

ROBERT W. KELLEY ODPC

Practice address

401 Main Street
Thompson Falls, MT 59873-0399

Phone

(406) 827-4327

Fax

(406) 827-3027

NPI assigned

Sep 28, 2006

Last updated

Feb 1, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert W Kelley

Title

President

Phone

(406) 827-4327

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1578655528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "THOMPSON FALLS",
            "state": "MT",
            "postal_code": "598730399",
            "telephone_number": "406-827-4327",
            "fax_number": "406-827-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 MAIN STREET",
            "city": "THOMPSON FALLS",
            "state": "MT",
            "postal_code": "598730399",
            "telephone_number": "406-827-4327",
            "fax_number": "406-827-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT W. KELLEY ODPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "406-827-4327"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD MT",
            "identifier": "26620",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME MEDICARE",
            "identifier": "0642010001",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "048-3119",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Thompson Falls, MT
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• Optometrist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; 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.