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General NPI Number Information
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NPI Number | 1841293263
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Entity Type | Individual
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Provider Name | KEITH ALAN BASINGER O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 340 ALEXANDERSVILLE RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-2554
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Country | US
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Telephone | 937-866-3471
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Fax | 937-866-5242
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Provider Business Mailing Address
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Address Line | 340 ALEXANDERSVILLE RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-2554
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Country | US
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Telephone | 937-866-3471
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Fax | 937-866-5242
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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 | 4438
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License Number State | OH
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