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Individual

KEITH A ROBERTS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
5855 RELIABLE PKWY, CHICAGO, IL 60686-0001
(812) 288-2029
(502) 736-4490
Mailing address
5855 RELIABLE PARKWAY, CHICAGO, IL 60686-0058
(812) 288-2029
(502) 736-4490

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
1735DT
KY
152W00000X
Optometrist
Primary
18003510A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200922030
IN
05
7100079400
KY
Enumeration date
09/12/2008
Last updated
06/14/2010
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