MEDICARE: TARA K KEESEY 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	02188	IA
2	152W00000X	Optometrist	046009288	IL
3	152W00000X	Optometrist	OPT.0004011	CO

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
2	23999	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1760415996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA K KEESEY OD

Provider Business Mailing Address
First Line	:	4344 WOODLANDS BLVD STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-688-3636
Fax Number	:	303-688-1036

Provider Business Practice Location Address
First Line	:	4344 WOODLANDS BLVD STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2801
Country	:	US
Telephone Number	:	303-688-3636
Fax Number	:	303-688-1036

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/03/2024

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Directions to “ TARA K KEESEY OD” Practice Location

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