Provider Demographics
NPI:1467617670
Name:KEITH E. WHALEY O.D.
Entity Type:Organization
Organization Name:KEITH E. WHALEY O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-428-0959
Mailing Address - Street 1:2541 SAND PIKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37863-6205
Mailing Address - Country:US
Mailing Address - Phone:865-428-0959
Mailing Address - Fax:
Practice Address - Street 1:2541 SAND PIKE BLVD
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6205
Practice Address - Country:US
Practice Address - Phone:865-428-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1729332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3041669OtherBCBS
TN3940567Medicaid
TN=========OtherJOHN DEERE HEALTHCARE
TN=========OtherCIGNA HEALTHCARE
TN=========OtherCHAMPVA
TN=========OtherHUMANA
TN3041669OtherBCBS
TN=========OtherUNITED HEALTHCARE
TN3940567Medicaid
TN=========OtherTRICARE FOR LIFE