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General NPI Number Information
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NPI Number | 1700058609
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Entity Type | Organization
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Legal Business Name | KEITEL EYE CARE, P.C.
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 1900 W 4TH ST
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City | MOUNT VERNON
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State | IN
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Zip | 47620-9407
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Country | US
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Telephone | 812-838-5526
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Fax | 812-838-6757
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Provider Business Mailing Address
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Address Line | 1900 W 4TH ST
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City | MOUNT VERNON
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State | IN
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Zip | 47620-9407
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Country | US
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Telephone | 812-838-5526
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Fax | 812-838-6757
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARIN W KEITEL
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Credential | O.D.
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Telephone | 812-838-5526
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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 | 18002587B
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License Number State | IN
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