Individual
PHILIP DALE KEYSOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0169428
—
OH
01
—
0804270001
MEDICAREB DME
OH
Enumeration date
08/13/2006
Last updated
12/06/2007
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