Organization
PHILLIP KEYSOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP KEYSOR (OWNER/OPTOMETRIST)
(419) 935-1505
Entity
Organization
Contact information
Practice address
219 CRESTWOOD DR, WILLARD, OH 44890-1650
(419) 935-1505
(419) 933-7071
Mailing address
219 CRESTWOOD DR, WILLARD, OH 44890-1650
(419) 935-1505
(419) 933-7071
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2984T512
OH
Other
Enumeration date
03/28/2008
Last updated
04/29/2008
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