Healthcare Provider Details

I. General information

NPI: 1841453198
Provider Name (Legal Business Name): BRUCE J KEENAN OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 AMHERST ST SUITE 204
WINCHESTER VA
22601
US

IV. Provider business mailing address

1014 AMHERST ST SUITE 204
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-0522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BRUCE KEENAN
Title or Position: OWNER
Credential: OD
Phone: 540-662-0522