Provider Demographics
NPI:1336230812
Name:KEISER, JOHNETTE (OD)
Entity type:Individual
Prefix:
First Name:JOHNETTE
Middle Name:
Last Name:KEISER
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 1:1017 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4027
Mailing Address - Country:US
Mailing Address - Phone:814-942-7184
Mailing Address - Fax:814-942-7137
Practice Address - Street 1:1017 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4027
Practice Address - Country:US
Practice Address - Phone:814-942-7184
Practice Address - Fax:814-942-7137
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA313740OtherUPMC
PA313740OtherUPMC
PA0161620001Medicare NSC
PA618877Medicare PIN