Provider Demographics
NPI:1972785707
Name:FORSHEE, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FORSHEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BROADWAY MALL
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1920
Mailing Address - Country:US
Mailing Address - Phone:607-324-4822
Mailing Address - Fax:
Practice Address - Street 1:34 BROADWAY MALL
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1920
Practice Address - Country:US
Practice Address - Phone:607-324-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00879314Medicaid
NYU67583Medicare UPIN
NYU19465Medicare UPIN
NY00879314Medicaid
NYB72455Medicare UPIN