Provider Demographics
NPI:1346258621
Name:KEELE, ANDREA RACHELE (OD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RACHELE
Last Name:KEELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RACHELE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19045 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7030
Mailing Address - Country:US
Mailing Address - Phone:816-795-7777
Mailing Address - Fax:816-795-1290
Practice Address - Street 1:1518 WALNUT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1313
Practice Address - Country:US
Practice Address - Phone:816-474-1916
Practice Address - Fax:816-474-4228
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSW79F032Medicare PIN