Healthcare Provider Details

I. General information

NPI: 1225110554
Provider Name (Legal Business Name): KEITH J MESSING OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 SAND BEACH RD
BAD AXE MI
48413
US

IV. Provider business mailing address

1226 SAND BEACH RD
BAD AXE MI
48413
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-6222
  • Fax: 989-269-4278
Mailing address:
  • Phone: 989-269-6222
  • Fax: 989-269-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberKM004019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: