Provider Demographics
NPI:1053311589
Name:KEE, ANTHONY SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SCOTT
Last Name:KEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 S CAROL MALONE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1352
Mailing Address - Country:US
Mailing Address - Phone:606-474-2940
Mailing Address - Fax:606-474-2944
Practice Address - Street 1:166 S CAROL MALONE BLVD
Practice Address - Street 2:STE A
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1352
Practice Address - Country:US
Practice Address - Phone:606-474-2940
Practice Address - Fax:606-474-2944
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1162DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000750Medicaid
KY9372001Medicare PIN
T92114Medicare UPIN
KY77000750Medicaid