MEDICARE: KELLER EYE CARE, L.L.C.

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
1	152W00000X	Optometrist	1359	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629251202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLER EYE CARE, L.L.C.

Provider Business Mailing Address
First Line	:	1066 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2247
Country	:	US
Telephone Number	:	864-582-0286
Fax Number	:	864-582-0279

Provider Business Practice Location Address
First Line	:	1066 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2247
Country	:	US
Telephone Number	:	864-582-0286
Fax Number	:	864-582-0279

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MRS. KELLY J SHARPTON
Credential	:
Telephone Number	:	864-582-0286

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/07/2007

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