Provider Demographics
NPI:1225018336
Name:KEIL, CHARLES JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:KEIL
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 1:428 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1595
Mailing Address - Country:US
Mailing Address - Phone:231-723-9961
Mailing Address - Fax:231-723-3606
Practice Address - Street 1:428 1ST ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1595
Practice Address - Country:US
Practice Address - Phone:231-723-9961
Practice Address - Fax:231-723-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0144960001Medicare NSC
MIT33230Medicare UPIN