Keith, Michael Allen

Keith, Michael Allen is an sole proprietor health care provider with primary practice located at 119 Boone Ridge Dr Suite 101, Johnson City TN 37615-4998. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Keith, Michael Allen can be contacted via phone (423) 283-7300.

Contact Information

Primary practice address
119 Boone Ridge Dr Suite 101 Johnson City TN 37615-4998
Phone: (423) 283-7300
Fax: (423) 283-4729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X T 1320 Tennessee

Profile Details

NPI number 1063528446
LBN Legal business name Keith, Michael Allen
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 21st, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063528446 NPPES
Tennessee MEDICAID 3597579

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