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General NPI Number Information
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NPI Number | 1851487474
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Entity Type | Individual
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Provider Name | KEITH WILLIAM CESPON OD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1700 CERRILLOS RD
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-946-9218
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Fax | 505-983-6243
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Provider Business Mailing Address
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Address Line | 1700 CERRILLOS RD
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City | SANTA FE
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State | NM
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Zip | 87505-3554
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Country | US
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Telephone | 505-946-9218
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Fax | 505-983-6243
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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 | 954
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License Number State | AZ
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