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General NPI Number Information
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NPI Number | 1750457370
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Entity Type | Organization
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Legal Business Name | JAY A KEESLING OD PA
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 1425 HAND AVE SUITE A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1135
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Country | US
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Telephone | 386-673-2020
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Fax | 386-672-1099
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Provider Business Mailing Address
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Address Line | 1425 HAND AVE SUITE A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1135
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Country | US
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Telephone | 386-673-2020
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Fax | 386-672-1099
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY A KEESLING
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Credential | OD
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Telephone | 386-673-2020
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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 |
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License Number State |
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