MEDICARE: DR. AMY R KELLER 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	5123	OH

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	:	1861494643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY R KELLER OD

Provider Business Mailing Address
First Line	:	5081 N HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-8001
Country	:	US
Telephone Number	:	174-739-8996
Fax Number	:	614-473-9906

Provider Business Practice Location Address
First Line	:	5081 N HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-8001
Country	:	US
Telephone Number	:	614-473-9899
Fax Number	:	614-473-9906

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/27/2020

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