Provider Demographics
NPI:1366411936
Name:SHUKE, KEITH FOSTER (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:FOSTER
Last Name:SHUKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MAIN ST
Mailing Address - Street 2:PO BOX 699
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522
Mailing Address - Country:US
Mailing Address - Phone:717-738-2488
Mailing Address - Fax:717-721-9088
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522
Practice Address - Country:US
Practice Address - Phone:717-738-2488
Practice Address - Fax:717-721-9088
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA801046NERMedicare PIN
U58064Medicare UPIN