Active NPI
Allicia K Kelly, O.D.
- Optometrist
- Fayetteville, AR
National Provider Identifier
1710325725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2783
- Practice address
- 1100 N College Ave
Optometry Clinic
Fayetteville, AR 72703-1944 - Phone
- (479) 443-4301
- NPI assigned
- Jun 12, 2013
- 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 | 2783 | OK | Primary |
| Optometrist | 152W00000X | 2696 | AR |
Addresses
Primary practice location
1100 N College Ave
Optometry Clinic
Fayetteville, AR 72703-1944
Mailing address
1100 N College Ave
Optometry Clinic
Fayetteville, AR 72703-1944
Phone (479) 443-4301
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2696 | AR | MD | Optometrist |
| 2783 | OK | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1710325725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 N COLLEGE AVE",
"address_2": "OPTOMETRY CLINIC",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031944",
"telephone_number": "479-443-4301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 N COLLEGE AVE",
"address_2": "OPTOMETRY CLINIC",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031944",
"telephone_number": "479-443-4301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ALLICIA",
"middle_name": "K",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-12",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "2783",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AR",
"license": "2696",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.