Provider Demographics
NPI:1568170520
Name:DONALD J KELLER MD PC
Entity Type:Organization
Organization Name:DONALD J KELLER MD PC
Other - Org Name:PANORAMA LASIK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUNCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-419-2673
Mailing Address - Street 1:PO BOX 200564
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0564
Mailing Address - Country:US
Mailing Address - Phone:970-221-2222
Mailing Address - Fax:
Practice Address - Street 1:1810 30TH ST STE B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1025
Practice Address - Country:US
Practice Address - Phone:720-358-9415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty