Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618000072 | VA |
NPI | 1013014067 |
---|---|
Provider Name | Dr. Anita Susan Keene |
First Address | Marion, VA 24354-4392 |
Second Address | Marion, VA 24354-4392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009234080 | (05) | VA |
U17937 | (02) |