Provider Demographics
NPI:1700058609
Name:KEITEL EYE CARE, P.C.
Entity Type:Organization
Organization Name:KEITEL EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEITEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-838-5526
Mailing Address - Street 1:1900 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-9407
Mailing Address - Country:US
Mailing Address - Phone:812-838-5526
Mailing Address - Fax:812-838-6757
Practice Address - Street 1:1900 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-9407
Practice Address - Country:US
Practice Address - Phone:812-838-5526
Practice Address - Fax:812-838-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002587B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100210210AMedicaid
0663550001Medicare NSC
INM100021656Medicare PIN