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General NPI Number Information
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NPI Number | 1467617670
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Entity Type | Organization
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Legal Business Name | KEITH E. WHALEY O.D.
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 2541 SAND PIKE BLVD
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City | PIGEON FORGE
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State | TN
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Zip | 37863-6205
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Country | US
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Telephone | 865-428-0959
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Fax |
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Provider Business Mailing Address
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Address Line | 2541 SAND PIKE BLVD
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City | PIGEON FORGE
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State | TN
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Zip | 37863-6205
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Country | US
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Telephone | 865-428-0959
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Fax |
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | MRS. VICKY G SEATON
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Credential |
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Telephone | 865-428-0959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OD1729
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License Number State | TN
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