Basic Information
| Provider Information | |||||||||
| NPI: | 1568170520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONALD J KELLER MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200564 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753200564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702212222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1810 30TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803011025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203589415 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2022 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | NIKISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 3077737144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.