Provider Demographics
NPI:1740957570
Name:KEATON, BROOK LAVINDER (OD)
Entity type:Individual
Prefix:MRS
First Name:BROOK
Middle Name:LAVINDER
Last Name:KEATON
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:BROOK
Other - Last Name:LAVINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1401 KRISTINA WAY UNIT 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8918
Mailing Address - Country:US
Mailing Address - Phone:757-424-4177
Mailing Address - Fax:757-424-0496
Practice Address - Street 1:1401 KRISTINA WAY UNIT 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8918
Practice Address - Country:US
Practice Address - Phone:757-424-4177
Practice Address - Fax:757-424-0496
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2664152W00000X
VA0618003125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist