Provider Demographics
NPI:1083765838
Name:KEENER, BRANDY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:KEENER
Suffix:
Gender:F
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:RR 3 BOX 261
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-9545
Mailing Address - Country:US
Mailing Address - Phone:304-265-2433
Mailing Address - Fax:304-265-5990
Practice Address - Street 1:1249 OLD NATIONAL PIKE
Practice Address - Street 2:HOPWOOD EYE CENTER
Practice Address - City:HOPWOOD
Practice Address - State:PA
Practice Address - Zip Code:15445
Practice Address - Country:US
Practice Address - Phone:304-265-0884
Practice Address - Fax:304-265-5990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017179960010Medicaid
PA002822Medicare ID - Type Unspecified
PAU68199Medicare UPIN