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General NPI Number Information
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NPI Number | 1942392410
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Entity Type | Organization
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Legal Business Name | KEETON VISION CARE, INC.
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 5901 MEXICO RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1613
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Country | US
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Telephone | 636-498-2020
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Fax | 636-498-0500
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Provider Business Mailing Address
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Address Line | 5901 MEXICO RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1613
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Country | US
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Telephone | 636-498-2020
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Fax | 636-498-0500
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. RANDALL CHARLES KEETON
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Credential |
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Telephone | 636-498-2020
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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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