Kelly, Stephen Michael

Kelly, Stephen Michael is an sole proprietor health care provider with primary practice located at 851 Cherry Ave Bayhill Center #25, San Bruno CA 94066-2900. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Kelly, Stephen Michael can be contacted via phone (650) 873-2020.

Contact Information

Primary practice address
851 Cherry Ave Bayhill Center #25 San Bruno CA 94066-2900
Phone: (650) 873-2020
Fax: (650) 873-5251
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OPT 6717 TPA California

Profile Details

NPI number 1770652349
LBN Legal business name Kelly, Stephen Michael
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 7th, 2006
Last updated Jul 8th, 2007 - about 18 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 1770652349 NPPES
California MEDICAID SD0067170

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