Provider Demographics
NPI:1053542530
Name:CYR, KELLY LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LOUISE
Last Name:CYR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 WOODGATE RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5466
Mailing Address - Country:US
Mailing Address - Phone:970-249-2330
Mailing Address - Fax:970-249-6131
Practice Address - Street 1:2770 WOODGATE RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5466
Practice Address - Country:US
Practice Address - Phone:970-249-2330
Practice Address - Fax:970-249-6131
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM619152W00000X, 152W00000X
CO2820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84983361Medicaid
NM1053542530OtherNATIONAL PROVIDER ID NUMBER
NMP00910104OtherMEDICARE RAILROAD CARRIER
CO9000165068Medicaid