Healthcare Provider Details

I. General information

NPI: 1700203825
Provider Name (Legal Business Name): COLLEEN GOULD KEIPER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LAKE LANSING RD
EAST LANSING MI
48823-1438
US

IV. Provider business mailing address

301 W LAKE LANSING RD
EAST LANSING MI
48823-1437
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-8182
  • Fax:
Mailing address:
  • Phone: 517-337-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004781
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: