Provider Demographics
NPI:1326181058
Name:MERRILL, KEITH ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:MERRILL
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 1:3101 SHANNON RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3571
Mailing Address - Country:US
Mailing Address - Phone:919-493-8508
Mailing Address - Fax:919-493-6153
Practice Address - Street 1:3101 SHANNON RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3571
Practice Address - Country:US
Practice Address - Phone:919-493-8508
Practice Address - Fax:919-493-6153
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist