Provider Demographics
NPI:1063558070
Name:KELLY AND VELAZQUEZ EYE CENTER PC
Entity type:Organization
Organization Name:KELLY AND VELAZQUEZ EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-284-4481
Mailing Address - Street 1:1504 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1215
Mailing Address - Country:US
Mailing Address - Phone:413-283-3511
Mailing Address - Fax:413-283-5396
Practice Address - Street 1:362 SEWALL ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2711
Practice Address - Country:US
Practice Address - Phone:413-589-7308
Practice Address - Fax:413-547-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41270332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA735819OtherTUFTS
MAMA1270OtherEYEMED
MA0218430001OtherDME MEDICARE
MA39707OtherDAVIS VISION
MAMA1270OtherEYEMED