Healthcare Provider Details

I. General information

NPI: 1083765838
Provider Name (Legal Business Name): BRANDY LYNN KEENER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 OLD NATIONAL PIKE HOPWOOD EYE CENTER
HOPWOOD PA
15445
US

IV. Provider business mailing address

RR 3 BOX 261
GRAFTON WV
26354-9545
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0884
  • Fax: 304-265-5990
Mailing address:
  • Phone: 304-265-2433
  • Fax: 304-265-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000423
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: