Provider Demographics
NPI:1861528416
Name:MEYER, C. KELLY (OD)
Entity type:Individual
Prefix:DR
First Name:C. KELLY
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CATHERINE KELLY
Other - Middle Name:
Other - Last Name:SIMYAN MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:138 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2289
Mailing Address - Country:US
Mailing Address - Phone:215-536-0612
Mailing Address - Fax:
Practice Address - Street 1:721 S WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2613
Practice Address - Country:US
Practice Address - Phone:215-538-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist