MEDICARE: DR. THOMAS SCOTT KEENE OD

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	1702	MN
2	152W00000X	Optometrist	1629	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2202054	OTHER	MN	MEDICA
2	283R3KE	OTHER	MN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649389743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS SCOTT KEENE OD

Provider Business Mailing Address
First Line	:	3015 HW 29 SOUTH
Second Line	:	SUITE 4010 MIDWEST VISION CENTER
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308
Country	:	US
Telephone Number	:	320-762-8104
Fax Number	:	320-762-1147

Provider Business Practice Location Address
First Line	:	3015 HW 29 SOUTH
Second Line	:	SUITE 4010 MIDWEST VISION CENTER
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308
Country	:	US
Telephone Number	:	320-762-8104
Fax Number	:	320-762-1147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. THOMAS SCOTT KEENE OD” Practice Location

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