Healthcare Provider Details

I. General information

NPI: 1245425347
Provider Name (Legal Business Name): JAY A KEESLING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 HAND AVE SUITE A
ORMOND BEACH FL
32174-1135
US

IV. Provider business mailing address

1425 HAND AVE SUITE A
ORMOND BEACH FL
32174-1135
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-2020
  • Fax:
Mailing address:
  • Phone: 386-673-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: