Provider Demographics
NPI:1568531572
Name:KOHORST, KEITH ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ANDREW
Last Name:KOHORST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 S HIGHWAY 160 STE 8
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4713
Mailing Address - Country:US
Mailing Address - Phone:775-727-7100
Mailing Address - Fax:
Practice Address - Street 1:1141 S HIGHWAY 160 STE 8
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4713
Practice Address - Country:US
Practice Address - Phone:775-727-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist