Provider Demographics
NPI:1336226547
Name:EMERY, KEITH ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
Last Name:EMERY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:55 CRYSTAL AVE
Mailing Address - Street 2:HOOD COMMONS
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1702
Mailing Address - Country:US
Mailing Address - Phone:603-434-2020
Mailing Address - Fax:603-437-1260
Practice Address - Street 1:55 CRYSTAL AVE
Practice Address - Street 2:HOOD COMMONS
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1702
Practice Address - Country:US
Practice Address - Phone:603-434-2020
Practice Address - Fax:603-437-1260
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHT25828Medicare UPIN
NHNH9078Medicare PIN