Provider Demographics
NPI:1861674707
Name:KEEN EYE VISION PLLC
Entity Type:Organization
Organization Name:KEEN EYE VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GRAVIET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-286-7296
Mailing Address - Street 1:457 N HANNAH PL
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 SOUTH SENECA SPRINGS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669
Practice Address - Country:US
Practice Address - Phone:208-898-4112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty