Provider Demographics
NPI:1306538343
Name:KEATING, TIFFANY GRACE (OD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:GRACE
Last Name:KEATING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 SCHNEIDERS CROSSING RD NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7224
Mailing Address - Country:US
Mailing Address - Phone:615-879-6629
Mailing Address - Fax:
Practice Address - Street 1:400 MILL AVE SE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3875
Practice Address - Country:US
Practice Address - Phone:330-339-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist