Provider Demographics
NPI:1730320482
Name:KELLER, ELLIOTT MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:MICHAEL
Last Name:KELLER
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 1:8674 ASHEVILLE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316
Mailing Address - Country:US
Mailing Address - Phone:864-804-6412
Mailing Address - Fax:864-804-6413
Practice Address - Street 1:8674 ASHEVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316
Practice Address - Country:US
Practice Address - Phone:864-804-6412
Practice Address - Fax:864-804-6413
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist