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General NPI Number Information
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NPI Number | 1457478158
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Entity Type | Organization
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Legal Business Name | KEYLON EYECARE, PC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 902 W MADISON AVE
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City | ATHENS
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State | TN
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Zip | 37303-3432
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Country | US
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Telephone | 423-745-8882
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Fax | 423-744-8428
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Provider Business Mailing Address
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Address Line | P.O BOX 826
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City | ATHENS
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State | TN
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Zip | 37371-0826
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Country | US
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Telephone | 423-745-8882
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Fax | 423-744-8428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES DAVID KEYLON
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Credential | OD
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Telephone | 423-745-8882
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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 | 503
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License Number State | TN
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