MEDICARE: MATTHEW KELLER 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
1	152W00000X	Optometrist	2156	AZ

General Provider Information

NPI Number	:	1700328762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KELLER O.D.

Provider Business Mailing Address
First Line	:	220 N MCKEMY AVE
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2654
Country	:	US
Telephone Number	:	480-961-1865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 N 75TH AVE STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-4533
Country	:	US
Telephone Number	:	623-849-0428
Fax Number	:	623-849-3649

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	09/14/2021

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