Individual
DR. KEITH RONALD MOULDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4643 ALPINE AVE NW, A, COMSTOCK PARK, MI 49321-8179
(616) 784-8700
(616) 784-8708
Mailing address
4643 ALPINE AVE NW, A, COMSTOCK PARK, MI 49321-8179
(616) 784-8700
(616) 784-8708
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004021
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
944431615
—
MI
Enumeration date
11/02/2005
Last updated
05/30/2012
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