Healthcare Provider Details

I. General information

NPI: 1154949147
Provider Name (Legal Business Name): GARRETT SCOTT KEE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 S CAROL MALONE BLVD STE A
GRAYSON KY
41143-1352
US

IV. Provider business mailing address

166 S CAROL MALONE BLVD STE A
GRAYSON KY
41143-1352
US

V. Phone/Fax

Practice location:
  • Phone: 606-474-2940
  • Fax:
Mailing address:
  • Phone: 606-474-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2186DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: