Provider Demographics
NPI:1093139438
Name:KEENEYE FAMILY VISION PC
Entity Type:Organization
Organization Name:KEENEYE FAMILY VISION PC
Other - Org Name:KEENEYE FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENYON
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-609-2020
Mailing Address - Street 1:252 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-7086
Mailing Address - Country:US
Mailing Address - Phone:801-609-2020
Mailing Address - Fax:801-609-2015
Practice Address - Street 1:252 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-7086
Practice Address - Country:US
Practice Address - Phone:801-609-2020
Practice Address - Fax:801-609-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8897506-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDV07151Medicare UPIN