Provider Demographics
NPI:1477517803
Name:SEHON, KEITH L (OD)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:SEHON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1537 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3135
Mailing Address - Country:US
Mailing Address - Phone:985-641-1195
Mailing Address - Fax:985-641-1193
Practice Address - Street 1:401 PONTCHARTRAIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4329
Practice Address - Country:US
Practice Address - Phone:985-641-1195
Practice Address - Fax:985-641-1193
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA852-198T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1903205Medicaid
LAT19455Medicare UPIN
LA1903205Medicaid