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General NPI Number Information
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NPI Number | 1508214347
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Entity Type | Individual
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Provider Name | ALYSSA KEATING O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2301 DEL PRADO BLVD S STE 820
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City | CAPE CORAL
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State | FL
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Zip | 33990-6624
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Country | US
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Telephone | 239-574-4443
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 162264
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-2264
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Country | US
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Telephone | 941-792-2020
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Fax | 239-936-8778
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC5244
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License Number State | FL
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