Provider Demographics
NPI:1194049973
Name:KEIL LASIK VISION CENTER, PLC
Entity type:Organization
Organization Name:KEIL LASIK VISION CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-365-5775
Mailing Address - Street 1:2500 E BELTLINE AVE SE
Mailing Address - Street 2:STE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5987
Mailing Address - Country:US
Mailing Address - Phone:616-365-5775
Mailing Address - Fax:616-365-5778
Practice Address - Street 1:2500 E BELTLINE AVE SE
Practice Address - Street 2:STE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5987
Practice Address - Country:US
Practice Address - Phone:616-365-5775
Practice Address - Fax:616-365-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014872207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty