Provider Demographics
NPI:1649389743
Name:KEENE, THOMAS SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:KEENE
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 1:3015 HW 29 SOUTH
Mailing Address - Street 2:SUITE 4010 MIDWEST VISION CENTER
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-762-8104
Mailing Address - Fax:320-762-1147
Practice Address - Street 1:3015 HW 29 SOUTH
Practice Address - Street 2:SUITE 4010 MIDWEST VISION CENTER
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-762-8104
Practice Address - Fax:320-762-1147
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1702152W00000X
WI1629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2202054OtherMEDICA
MN283R3KEOtherBCBS
MN6844823100Medicaid
MN283R3KEOtherBCBS