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General NPI Number Information
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NPI Number | 1083596084
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Entity Type | Individual
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Provider Name | ALYSSA KELLER OD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 950 3RD AVE FL 3
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City | NEW YORK
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State | NY
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Zip | 10022-2793
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Country | US
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Telephone | 212-861-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BROAD ST APT 828
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City | NEW YORK
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State | NY
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Zip | 10005-1963
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Country | US
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Telephone | 479-899-1358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 011226
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License Number State | NY
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