Provider Demographics
NPI:1740577584
Name:KELLER, JENNIFER M (OD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:100 HUNTSINGER AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470
Mailing Address - Country:US
Mailing Address - Phone:218-732-3389
Mailing Address - Fax:218-732-5994
Practice Address - Street 1:100 HUNTSINGER AVE
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470
Practice Address - Country:US
Practice Address - Phone:218-732-3389
Practice Address - Fax:218-732-5994
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist