Provider Demographics
NPI:1699165357
Name:KELLY, AZADEH (OD)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AZADEH
Other - Middle Name:
Other - Last Name:KARIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:30 TURNPIKE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2114
Mailing Address - Country:US
Mailing Address - Phone:508-481-8558
Mailing Address - Fax:
Practice Address - Street 1:33 BROAD ST LBBY 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4229
Practice Address - Country:US
Practice Address - Phone:617-742-7200
Practice Address - Fax:617-742-7272
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ152W00000X
MA5075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist