Provider Demographics
NPI:1821065418
Name:KEEL, MICHELE PHILBRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:PHILBRICK
Last Name:KEEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:PHILBRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 FOX HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8510
Mailing Address - Country:US
Mailing Address - Phone:910-692-3937
Mailing Address - Fax:910-692-5908
Practice Address - Street 1:160 FOX HOLLOW CT
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8510
Practice Address - Country:US
Practice Address - Phone:910-692-3937
Practice Address - Fax:910-692-5908
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0905BOtherBCBS
NC890903CMedicaid
NC890905BMedicaid
NC890903CMedicaid
U39498Medicare UPIN