Kelly, James Michael

Kelly, James Michael is an individual health care provider with primary practice located at 489 Taft Ave Ste 100 , Glen Ellyn IL 60137-8209. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Kelly, James Michael can be contacted via phone (630) 790-1300.

Contact Information

Primary practice address
489 Taft Ave Ste 100 Glen Ellyn IL 60137-8209
Phone: (630) 790-1300
Fax: (630) 790-1378
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046-008415 Illinois

Profile Details

NPI number 1154309524
LBN Legal business name Kelly, James Michael
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 5th, 2006
Last updated Jan 13th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154309524 NPPES
Illinois Other 2232411 BLUE CROSS BLUE SHIELD

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