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General NPI Number Information
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NPI Number | 1194541110
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Entity Type | Organization
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Legal Business Name | KEATON OPTOMETRY INC.
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1401 KRISTINA WAY UNIT 100
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City | CHESAPEAKE
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State | VA
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Zip | 23320-8918
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Country | US
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Telephone | 757-424-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 KRISTINA WAY UNIT 100
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City | CHESAPEAKE
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State | VA
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Zip | 23320-8918
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Country | US
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Telephone | 757-424-4177
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/BUSINESS OWNER
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Name | DR. BROOK LAVINDER KEATON
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Credential | OD
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Telephone | 540-922-3847
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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 |
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License Number State |
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