Provider Demographics
NPI:1558397307
Name:DAY-KELLER, STEPHANIE L (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:DAY-KELLER
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 1:7653 S PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47557-7154
Mailing Address - Country:US
Mailing Address - Phone:812-291-0507
Mailing Address - Fax:
Practice Address - Street 1:2020 CLEARVIEW DR.
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591
Practice Address - Country:US
Practice Address - Phone:812-882-9600
Practice Address - Fax:812-882-2944
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002772A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU61876Medicare UPIN