Provider Demographics
NPI:1316154750
Name:RICHARD P KEVILLE OD & ASSOCIATES PA
Entity type:Organization
Organization Name:RICHARD P KEVILLE OD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-756-4108
Mailing Address - Street 1:2901 50TH PL E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3824
Mailing Address - Country:US
Mailing Address - Phone:941-756-4108
Mailing Address - Fax:
Practice Address - Street 1:2911 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4312
Practice Address - Country:US
Practice Address - Phone:941-758-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24537OtherSPECTERA BRADENTON
FL53759OtherDAVIS PALMETTO
FL26816OtherMEDICAL EYE SERVICES
FL47866OtherDAVIS BRADENTON
FL45306OtherSPECTERA PALMETTO
FL19974Medicare ID - Type Unspecified
FL53759OtherDAVIS PALMETTO