MEDICARE: JAY A KEESLING OD PA

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1750457370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY A KEESLING OD PA

Provider Business Mailing Address
First Line	:	1425 HAND AVE
Second Line	:	SUITE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1135
Country	:	US
Telephone Number	:	386-673-2020
Fax Number	:	386-672-1099

Provider Business Practice Location Address
First Line	:	1425 HAND AVE
Second Line	:	SUITE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1135
Country	:	US
Telephone Number	:	386-673-2020
Fax Number	:	386-672-1099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY A KEESLING
Credential	:	OD
Telephone Number	:	386-673-2020

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	02/21/2008

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