Provider Demographics
NPI:1679568695
Name:ROWLANDS, KEITH T (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:T
Last Name:ROWLANDS
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 1:138 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1012
Mailing Address - Country:US
Mailing Address - Phone:724-662-4313
Mailing Address - Fax:
Practice Address - Street 1:138 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-1012
Practice Address - Country:US
Practice Address - Phone:724-662-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA436709Medicare PIN
PA0246010001Medicare NSC
PAT30429Medicare UPIN