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Individual

GREGORY LEE KEITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
119 BOONE RIDGE DR, SUITE 101, JOHNSON CITY, TN 37615-4998
(423) 283-7300
(423) 283-4729
Mailing address
119 BOONE RIDGE DR, SUITE 101, JOHNSON CITY, TN 37615-4998
(423) 283-7300
(423) 283-4729

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
2046
VA
152W00000X
Optometrist
Primary
ODT1679
TN

Other

Enumeration date
11/01/2006
Last updated
07/08/2007
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