Provider Demographics
NPI:1104174051
Name:KELLER EYE CENTER, P.A.
Entity type:Organization
Organization Name:KELLER EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-330-3199
Mailing Address - Street 1:2301 INDUSTRIAL RD
Mailing Address - Street 2:STE 2020
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6656
Mailing Address - Country:US
Mailing Address - Phone:620-343-8876
Mailing Address - Fax:
Practice Address - Street 1:2301 INDUSTRIAL RD
Practice Address - Street 2:STE 2020
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6656
Practice Address - Country:US
Practice Address - Phone:620-343-8876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty