DR. NICKELLE ANNE KELLOUGH (NPI# 1669600102) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669600102 |
| Entity Type | Individual |
| Full Name | DR. NICKELLE ANNE KELLOUGH |
| Credential | OD |
| Practice Address |
300 S Park Rd Ste 300 Hollywood FL 33021-8353 |
| Practice Telephone | 9549252740 |
| Practice Fax Number | 9549238379 |
| Mailing Telephone | 9549252740 |
| Mailing Fax Number | 9549238379 |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-06-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | OPC3480 | FL | Eye and Vision Services Providers |
| Street Address |
300 S PARK RD STE 300 |
| City | HOLLYWOOD |
| State | FL |
| Zip Code | 33021-8353 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962499376 | Mark S Dorfman | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2005-09-30 |
| 1396382719 | Eye Surgery Associates LLC | Optometrist | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2019-12-04 |
| 1730573049 | Jacquelyn Daubert | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2015-03-25 |
| 1538507157 | Maria Cristina Fernandez-ruiz | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2013-06-05 |
| 1154527851 | Albert Gasper Caruana Jr. | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2007-06-21 |
| 1861589343 | Eye Surgery Associates LLC | Specialist | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2006-10-06 |
| 1124055736 | Michael Glassman | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2006-06-27 |
| 1215998471 | David T Jones | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2006-03-29 |
| 1134116551 | Guy Angella | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2005-09-30 |
| 1033106455 | Scott C Cardone | Ophthalmology | 300 S Park Rd Ste 300, Hollywood, FL 33021-8353 | 2005-09-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548893894 | Seminole Tribe of Florida Health Department | Pharmacy | 111 W. Coral Way, Hollywood, FL 33021 | 2020-02-14 |
| 1437714086 | Emilia Roxana Gucciardo | Physician Assistant | 4510 Sheridan Street, Attn: William Pepe, Hollywood, FL 33021 | 2019-05-08 |
| 1649763673 | Sabrina Shoba Mathura | Behavior Technician | 4400 Madison St, Hollywood, FL 33021 | 2018-06-13 |
| 1558850149 | South Broward Hospital District | Pediatrics | 105 Joe Dimaggio Dr, Pediatric Heart Station, Hollywood, FL 33021 | 2018-05-09 |
| 1942798368 | Kyndra Monique Liburd | Student in an Organized Health Care Education/Training Program | Attn: Pediatric Residency Program, 1005 Joe Dimaggio Drive, Hollywood, FL 33021 | 2018-05-01 |
| 1992292106 | Madeleine Mariela Reyes | Nurse Practitioner | 5010 Hollywood Boulevard #100-b, Hollywood, FL 33021 | 2018-04-13 |
| 1487168233 | Gynecologic Oncology & Urogynecology | Obstetrics & Gynecology | 1150 N 35th Ave Ste 670, Hollywood, FL 33021 | 2017-11-30 |
| 1245743012 | Healix Healthcare Services, LLC | Obstetrics & Gynecology | 3990 Sheridan St Ste 207, Hollywood, FL 33021 | 2017-11-14 |
| 1093233587 | Benjamin Laborde | Physical Therapy Assistant | 4200 Washington Street, Hollywood, FL 33021 | 2017-09-05 |
| 1477079358 | Tt Trans, LLC | Non-emergency Medical Transport (VAN) | 3550 Washington Street, 502, Hollywood, FL 33021 | 2017-08-22 |
| Find all providers in zip 33021 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770125155 | Youssef Choucair | Optometrist | 1050 N Federal Hwy, Hollywood, FL 33020-3540 | 2019-10-17 |
| 1326505488 | Bluma Dukesz Od Pllc | Optometrist | 3240 N 37th St, Hollywood, FL 33021-2636 | 2019-02-25 |
| 1962906701 | Druey Vision Retail Group LLC | Optometrist | 333 S State Road 7 Unit A, Hollywood, FL 33023-6760 | 2018-03-19 |
| 1831629278 | Brittany Rozen Noskow | Optometrist | 11011 Sheridan St Ste 215, Hollywood, FL 33026-1531 | 2017-06-18 |
| 1265973929 | Broward Optimum Eye Care P.a. | Optometrist | 3900 Fern Forest Rd, Hollywood, FL 33026-1172 | 2017-03-14 |
| 1255879979 | Daniel Max & Marc Andrea LLC | Optometrist | 333 S State Road 7 Ste B, Hollywood, FL 33023-6756 | 2017-02-01 |
| 1144778804 | Eyes On The Job Pllc | Optometrist | 5640 Hollywood Blvd, Hollywood, FL 33021-6351 | 2016-09-12 |
| 1013369511 | Cristen Adams | Optometrist | 6288 Hollywood Blvd, Hollywood, CA 90028-5309 | 2016-07-07 |
| 1710395405 | Willian Rapoport | Optometrist | 837 Spinnaker Dr E, Hollywood, FL 33019-5026 | 2014-07-26 |
| 1124455639 | Samand Sebghati | Optometrist | 7400 Palomino Dr, Apt # 522, Hollywood, FL 33024-2349 | 2013-09-28 |
| Find all providers in HOLLYWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.