Kelly Willard, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2452 Issued in SC

Practice address

8084 Rivers Ave Ste 202
North Charleston, SC 29406-9235

Phone

(800) 485-9196

NPI assigned

Jul 5, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelly.varney.p3@direct.midwesternuniversity.nextgenshare.com
• Direct secure messaging: kwillard18582@direct.midwestern.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midwestern University

  dba Midwestern University Multispecialty Clinic

  • Multi-Specialty Clinic/Center
  • Glendale, AZ
  • NPI 1932206414

  Optometrist

  Medicare reassignment NPD
• Midwestern University

  dba Midwestern University Eye Institute-Downers Grove

  • Optometrist
  • Downers Grove, IL
  • NPI 1295126324
  NPD
• Midwestern University

  dba Midwestern University Eye Institute

  • Optometrist
  • Glendale, AZ
  • NPI 1891017745
  NPD
• Vision to Learn

  • Optometrist
  • Los Angeles, CA
  • NPI 1396142766
  NPD

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1982056750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 SWEET ALYSSUM DR",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294563898",
            "telephone_number": "773-759-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8084 RIVERS AVE STE 202",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069235",
            "telephone_number": "800-485-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "KELLY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-05",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "2211",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Anne Wilcox, RN, BSN
• Sue-Ann Wildman, MD
• Shelley Wilds, RN, BSN
• Robin Margaret Wilkening, MD, MPH
• Anna Clar Wilks, RN
• Miranda Frances Willard, LISW-CP
• Tawana N Williams Faye, RN
• Megan Angela Marie Williams Morais, RDN
• Andre Williams, LPN
• Ashton Williams, RN, BSN

• Optometrist in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.