MEDICARE: DR. KEITH J MESSING OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	KM004019	MI

General Provider Information

NPI Number	:	1225110554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH J MESSING OD

Provider Business Mailing Address
First Line	:	1226 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413
Country	:	US
Telephone Number	:	989-269-6222
Fax Number	:	989-269-4278

Provider Business Practice Location Address
First Line	:	1226 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413
Country	:	US
Telephone Number	:	989-269-6222
Fax Number	:	989-269-4278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/23/2008

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