Provider Demographics
NPI:1326334731
Name:KEITH CLAY OPTOMETRY
Entity Type:Organization
Organization Name:KEITH CLAY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-837-2014
Mailing Address - Street 1:137 PEACHTREE ST
Mailing Address - Street 2:SUITE 3 PROFESSIONAL BUILDING
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-2909
Mailing Address - Country:US
Mailing Address - Phone:828-837-2014
Mailing Address - Fax:828-837-7046
Practice Address - Street 1:137 PEACHTREE ST
Practice Address - Street 2:SUITE 3 PROFESSIONAL BUILDING
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2909
Practice Address - Country:US
Practice Address - Phone:828-837-2014
Practice Address - Fax:828-837-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890915KMedicaid
NC0625040001Medicare NSC
NC890915KMedicaid
NC2468703Medicare PIN