Provider Demographics
NPI:1376632539
Name:NEAL, ROBERT KEIL (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEIL
Last Name:NEAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:27010 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8319
Mailing Address - Country:US
Mailing Address - Phone:425-413-8787
Mailing Address - Fax:425-413-4012
Practice Address - Street 1:27010 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8319
Practice Address - Country:US
Practice Address - Phone:425-413-8787
Practice Address - Fax:425-413-4012
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028967Medicaid
WAG8802058Medicare ID - Type Unspecified
WA2028967Medicaid