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General NPI Number Information
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NPI Number | 1861674707
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Entity Type | Organization
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Legal Business Name | KEEN EYE VISION PLLC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 170 SOUTH SENECA SPRINGS WAY SUITE 100
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City | STAR
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State | ID
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Zip | 83669
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Country | US
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Telephone | 208-898-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 457 N HANNAH PL
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City | STAR
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State | ID
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Zip | 83669-5640
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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 | OWNER
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Name | DR. JEFFREY PAUL GRAVIET
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Credential | O.D.
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Telephone | 208-286-7296
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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 |
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License Number State |
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