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General NPI Number Information
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NPI Number | 1316154750
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Entity Type | Organization
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Legal Business Name | RICHARD P KEVILLE OD & ASSOCIATES PA
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 2911 53RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-4312
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Country | US
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Telephone | 941-758-5960
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 50TH PL E
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City | BRADENTON
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State | FL
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Zip | 34203-3824
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Country | US
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Telephone | 941-756-4108
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD P. KEVILLE
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Credential | O.D.
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Telephone | 941-756-4108
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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 | OPC002064
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License Number State | FL
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