Healthcare Provider Details

I. General information

NPI: 1083595169
Provider Name (Legal Business Name): JACOB PAUL KEENER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 CENTURY PL SE
HICKORY NC
28602-4031
US

IV. Provider business mailing address

PO BOX 3445
HICKORY NC
28603-3445
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-2050
  • Fax: 828-345-0522
Mailing address:
  • Phone: 828-322-2050
  • Fax: 828-345-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2880
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: