Individual
KEELY DOREEN ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
95 N TENNESSEE ST, DANVILLE, IN 46122-1223
(317) 699-2000
Mailing address
95 N TENNESSEE ST, DANVILLE, IN 46122-1223
(317) 699-2000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003426A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000490514
ANTHEM PIN
IN
05
—
200854310
—
IN
01
—
P00371968
RR MEDICARE
IN
Enumeration date
07/18/2006
Last updated
09/28/2015
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