Provider Demographics
NPI:1245417062
Name:JOHNETTE KEISER, P.C.
Entity Type:Organization
Organization Name:JOHNETTE KEISER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-942-7184
Mailing Address - Street 1:1017 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4027
Mailing Address - Country:US
Mailing Address - Phone:814-942-7184
Mailing Address - Fax:814-942-7137
Practice Address - Street 1:1017 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4027
Practice Address - Country:US
Practice Address - Phone:814-942-7184
Practice Address - Fax:814-942-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000783152W00000X
PAOE000873332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA313740OtherUPMC
PA410023759OtherRR MEDICARE
PAU06349Medicare UPIN
PA618877Medicare PIN
PA313740OtherUPMC