Provider Demographics
NPI:1114295789
Name:BUCHANAN KEENE, AMY DEE-LYTE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DEE-LYTE
Last Name:BUCHANAN KEENE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:DEE-LYTE
Other - Last Name:KEENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:220 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8428
Mailing Address - Country:US
Mailing Address - Phone:423-967-6531
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017
Practice Address - Country:US
Practice Address - Phone:336-386-8526
Practice Address - Fax:336-386-4180
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002153152W00000X
TN3007152W00000X
WV2055-IOD152W00000X
NC2286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114295789Medicaid
VA1114295789Medicaid