Provider Demographics
NPI:1922089101
Name:KEPPICH, TODD MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:KEPPICH
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 1:2121 SHELLY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2395
Mailing Address - Country:US
Mailing Address - Phone:724-349-1237
Mailing Address - Fax:724-465-0127
Practice Address - Street 1:2121 SHELLY DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2395
Practice Address - Country:US
Practice Address - Phone:724-349-1237
Practice Address - Fax:724-465-0127
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800384152W00000X
PAOEG002045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0601800384OtherSTATE LICENSE NUMBER
PAOEG002045OtherSTATE LICENSE
VA0601800384OtherSTATE LICENSE NUMBER
VAU91001Medicare UPIN
PAOEG002045OtherSTATE LICENSE