Provider Demographics
NPI:1871648865
Name:KEENER, RODERICK JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:JOHN
Last Name:KEENER
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 1:6 PARK GATE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5721
Mailing Address - Country:US
Mailing Address - Phone:925-283-0531
Mailing Address - Fax:
Practice Address - Street 1:1530 BONANZA ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4524
Practice Address - Country:US
Practice Address - Phone:925-934-3388
Practice Address - Fax:925-944-8833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist