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General NPI Number Information
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NPI Number | 1548759533
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Entity Type | Organization
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Legal Business Name | KEELAYBOY LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 2031 S FEDERAL BLVD
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City | DENVER
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State | CO
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Zip | 80219-5429
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Country | US
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Telephone | 303-934-0942
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Fax |
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Provider Business Mailing Address
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Address Line | 21912 E CANYON PL
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City | AURORA
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State | CO
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Zip | 80016-7215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | JEFFREY HAVEL
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Credential | OD
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Telephone | 720-507-6280
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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 | OPT0003106
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License Number State | CO
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