MEDICARE: KEEN EYE FAMILY VISION PA

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	ODP-100087	ID

General Provider Information

NPI Number	:	1720276371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEEN EYE FAMILY VISION PA

Provider Business Mailing Address
First Line	:	2540 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7515
Country	:	US
Telephone Number	:	208-529-2700
Fax Number	:	208-529-0873

Provider Business Practice Location Address
First Line	:	2540 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7515
Country	:	US
Telephone Number	:	208-529-2700
Fax Number	:	208-529-0873

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENYON ANDERSON
Credential	:	O.D.
Telephone Number	:	208-529-2700

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	02/14/2012

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