Provider Demographics
NPI:1992523641
Name:GARNEAU, KEITH CHRIS
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:CHRIS
Last Name:GARNEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NEW LOUDON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2825
Mailing Address - Country:US
Mailing Address - Phone:518-783-4086
Mailing Address - Fax:
Practice Address - Street 1:800 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3900
Practice Address - Country:US
Practice Address - Phone:518-783-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4920156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician