Provider Demographics
NPI:1336716125
Name:KEELER, MEREDITH FERN (OD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:FERN
Last Name:KEELER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 44TH ST S UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8521
Mailing Address - Country:US
Mailing Address - Phone:701-235-0561
Mailing Address - Fax:
Practice Address - Street 1:3171 44TH ST S UNIT 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8521
Practice Address - Country:US
Practice Address - Phone:701-235-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist