Provider Demographics
NPI:1689638785
Name:KEIRSEY, KENNETH J (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:KEIRSEY
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 1:608 N MAGUIRE ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1420
Mailing Address - Country:US
Mailing Address - Phone:660-747-7300
Mailing Address - Fax:660-747-5322
Practice Address - Street 1:608 N MAGUIRE ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1420
Practice Address - Country:US
Practice Address - Phone:660-747-7300
Practice Address - Fax:660-747-5322
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18576011OtherBLUE CROSS BLUE SHIELD KC
MO18576011Medicaid
MO313476715Medicaid
04580012OtherBLUE CROSS BLUE SHIELD KC 8 DIGIT BILLING NUBER
410021570Medicare PIN
U37033Medicare UPIN
G493468BMedicare PIN
18576011OtherBLUE CROSS BLUE SHIELD KC
410036168Medicare PIN
04580012OtherBLUE CROSS BLUE SHIELD KC 8 DIGIT BILLING NUBER
MO18576011Medicaid
0710770001Medicare NSC