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NPI Code Detail

MEDICARE: DR. KEITH ALLEN HOLDEN O.D.

MEDICARE: DR. KEITH ALLEN HOLDEN O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4939OH

General Provider Information

NPI Number : 1548256712
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH ALLEN HOLDEN O.D.
Provider Business Mailing Address
First Line : 5224 TERRACE TRACE CT
Second Line :
City : MILFORD
State : OH
Zip : 45150-5820
Country : US
Telephone Number : 513-831-8376
Fax Number : 513-794-9965
Provider Business Practice Location Address
First Line : 7840 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45236-4301
Country : US
Telephone Number : 513-794-9964
Fax Number : 513-794-9965
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 07/08/2007

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