Healthcare Provider Details

I. General information

NPI: 1366390031
Provider Name (Legal Business Name): MCKENNA RAE KEYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 W MAIN ST
IONIA MI
48846-1652
US

IV. Provider business mailing address

750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-6049
US

V. Phone/Fax

Practice location:
  • Phone: 616-588-6598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: