Provider Demographics
NPI:1528410933
Name:KEELE, JAMIE (OD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KEELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6004 MCMINNVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3814
Mailing Address - Country:US
Mailing Address - Phone:931-247-2165
Mailing Address - Fax:
Practice Address - Street 1:1642 MCARTHUR ST # 101
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2522
Practice Address - Country:US
Practice Address - Phone:931-728-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3337OtherOPTOMETRY LICENSE