Organization
KEITH A. MALLATT OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH ALLEN MALLATT O.D. (OWNER)
(620) 231-1720
Entity
Organization
Contact information
Practice address
301 N BROADWAY ST, PITTSBURG, KS 66762-4806
(620) 231-1720
(620) 231-1727
Mailing address
301 N BROADWAY ST, PITTSBURG, KS 66762-4806
(620) 231-1720
(620) 231-1727
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
KS 1173-2
KS
Other
Enumeration date
11/03/2007
Last updated
04/20/2010
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