Provider Demographics
NPI:1538852512
Name:KEATING, BRENT MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:MICHAEL
Last Name:KEATING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 SCHNEIDERS CROSSING RD NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7224
Mailing Address - Country:US
Mailing Address - Phone:330-440-2185
Mailing Address - Fax:
Practice Address - Street 1:707 N WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2866
Practice Address - Country:US
Practice Address - Phone:330-365-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist