Provider Demographics
NPI:1750457370
Name:JAY A KEESLING OD PA
Entity type:Organization
Organization Name:JAY A KEESLING OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEESLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-673-2020
Mailing Address - Street 1:1425 HAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1135
Mailing Address - Country:US
Mailing Address - Phone:386-673-2020
Mailing Address - Fax:386-672-1099
Practice Address - Street 1:1425 HAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1135
Practice Address - Country:US
Practice Address - Phone:386-673-2020
Practice Address - Fax:386-672-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1249540001Medicare NSC