Provider Demographics
NPI:1881635548
Name:DELPRINCE, KEITH F (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:F
Last Name:DELPRINCE
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 1:980 WEST MAPLE COURT
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9530
Mailing Address - Country:US
Mailing Address - Phone:716-652-0870
Mailing Address - Fax:716-652-2071
Practice Address - Street 1:980 WEST MAPLE COURT
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9530
Practice Address - Country:US
Practice Address - Phone:716-652-0870
Practice Address - Fax:716-652-2071
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT4730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU02478Medicare UPIN
NYC67903Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID