Provider Demographics
NPI:1194725382
Name:KELL, HANS M (OD)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:M
Last Name:KELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 OAKBANK DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3611
Mailing Address - Country:US
Mailing Address - Phone:281-713-2421
Mailing Address - Fax:
Practice Address - Street 1:1714 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3046
Practice Address - Country:US
Practice Address - Phone:281-359-2020
Practice Address - Fax:303-673-9578
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1480152W00000X
TX7322T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01908774Medicaid
COCA0853Medicare PIN
COU61701Medicare UPIN