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General NPI Number Information
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NPI Number | 1245417062
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Entity Type | Organization
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Legal Business Name | JOHNETTE KEISER, P.C.
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 1017 LOGAN BLVD
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City | ALTOONA
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State | PA
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Zip | 16602-4027
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Country | US
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Telephone | 814-942-7184
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Fax | 814-942-7137
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Provider Business Mailing Address
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Address Line | 1017 LOGAN BLVD
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City | ALTOONA
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State | PA
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Zip | 16602-4027
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Country | US
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Telephone | 814-942-7184
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Fax | 814-942-7137
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. JOHNETTE KEISER
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Credential | O.D.
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Telephone | 814-942-7184
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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 | OEG000783
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OE000873
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License Number State | PA
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