Provider Demographics
NPI:1871636621
Name:KEAST, SHANE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:KEAST
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 1:1070 GREENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5404
Mailing Address - Country:US
Mailing Address - Phone:407-897-3582
Mailing Address - Fax:407-897-3621
Practice Address - Street 1:3817 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5207
Practice Address - Country:US
Practice Address - Phone:407-897-3582
Practice Address - Fax:407-897-3621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV07552Medicare UPIN
FLK8974Medicare ID - Type Unspecified
FLU6560ZMedicare PIN