Provider Demographics
NPI:1891216925
Name:MILOSHOFF, KEITH MITCHELL (OD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:MITCHELL
Last Name:MILOSHOFF
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 1:1111 W MAIN ST APT 302
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1588
Mailing Address - Country:US
Mailing Address - Phone:219-308-5704
Mailing Address - Fax:
Practice Address - Street 1:16409 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8470
Practice Address - Country:US
Practice Address - Phone:317-896-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004048A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist