Provider Demographics
NPI:1124082912
Name:KALLAUR, KELLIANN DIGNAM (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:KELLIANN
Middle Name:DIGNAM
Last Name:KALLAUR
Suffix:
Gender:
Credentials:OD, FAAO
Other - Prefix:DR
Other - First Name:KELLIANN
Other - Middle Name:DIGNAM
Other - Last Name:KALLAUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD, FAAO
Mailing Address - Street 1:2131 FOLKSTONE RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3312
Mailing Address - Country:US
Mailing Address - Phone:443-895-0720
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS, VA EYE CLINIC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7230
Practice Address - Fax:410-605-7232
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist