Provider Demographics
NPI:1477962850
Name:RODEN, KEISHA (OD)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:
Last Name:RODEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BAYCHESTER AVENUE
Mailing Address - Street 2:MALL AT BAY PLAZA. COHEN'S FASHION OPTICAL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:718-320-7700
Mailing Address - Fax:718-320-7709
Practice Address - Street 1:220 BAYCHESTER AVENUE
Practice Address - Street 2:MALL AT BAY PLAZA. COHEN'S FASHION OPTICAL # 285
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:718-320-7700
Practice Address - Fax:718-320-7709
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist