Provider Demographics
NPI:1811037906
Name:KEELAN, PATRICK JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:KEELAN
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 1:466 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2008
Mailing Address - Country:US
Mailing Address - Phone:732-363-3487
Mailing Address - Fax:
Practice Address - Street 1:149 VAN ZILE RD
Practice Address - Street 2:KEELAN EYECARE
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3158
Practice Address - Country:US
Practice Address - Phone:732-458-4800
Practice Address - Fax:732-458-4877
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223599367OtherTAX ID
NJ159837ZED2Medicare PIN