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Individual

DR. THOMAS J KEENAN IV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1627 MIDLAND TRL, SHELBYVILLE, KY 40065-1638
(502) 633-2985
(502) 647-0327
Mailing address
1627 MIDLAND TRL, SHELBYVILLE, KY 40065-1638
(502) 633-2985
(502) 647-0327

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1008DT
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000350873
ANTHEM BCBS
KY
01
000000350897
ANTHEM BCBS
KY
01
1008DT
OD LICENSE NUMBER
KY
05
77010080
KY
01
P00185446
RR MEDICARE
KY
Enumeration date
08/16/2005
Last updated
02/19/2014
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