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Individual

DR. MICHAEL ALLEN KEITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
119 BOONE RIDGE DR, SUITE 101, JOHNSON CITY, TN 37615-4998
(423) 283-7300
(423) 283-4729
Mailing address
119 BOONE RIDGE DR, SUITE 101, JOHNSON CITY, TN 37615-4998
(423) 283-7300
(423) 283-4729

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T 1320
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3597579
TN
Enumeration date
08/21/2006
Last updated
07/08/2007
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