Provider Demographics
NPI:1275642530
Name:KEISER, MARY CELESTE (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CELESTE
Last Name:KEISER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:KEISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8315 BEECHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-6140
Mailing Address - Country:US
Mailing Address - Phone:513-474-4444
Mailing Address - Fax:513-474-7915
Practice Address - Street 1:8315 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6140
Practice Address - Country:US
Practice Address - Phone:513-474-4444
Practice Address - Fax:513-474-7915
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4455 / T1139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
311645431OtherAETNA
311645431OtherHUMANA
000000122752OtherANTHEM
311645431OtherU.H.C.
311645431OtherU.H.C.
OH0748176Medicare PIN