Keith L Tully, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

8732T Issued in TX

Practice address

810 W Ocean Blvd
Suite C2
Los Fresnos, TX 78566-3600

Phone

(956) 233-5252

Fax

(956) 233-6430

NPI assigned

Jun 29, 2015

Last updated

Jun 29, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Los Fresnos Eye Clinic & Optical Inc.

  • Optometrist
  • Los Fresnos, TX
  • NPI 1215115118
  Medicare reassignment NPD
• Empire Vision Center Inc

  dba Davis Vision

  • Optometrist
  • Syracuse, NY
  • NPI 1750358826
  Medicare reassignment NPD
• Empire Vision Center, Inc

  dba Visionworks

  • Eyewear Supplier
  • Attleboro, MA
  • NPI 1730635582
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435536000000",
    "number": "1033591821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 W OCEAN BLVD",
            "address_2": "SUITE C2",
            "city": "LOS FRESNOS",
            "state": "TX",
            "postal_code": "785663600",
            "telephone_number": "956-233-5252",
            "fax_number": "956-233-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 W OCEAN BLVD",
            "address_2": "SUITE C2",
            "city": "LOS FRESNOS",
            "state": "TX",
            "postal_code": "785663600",
            "telephone_number": "956-233-5252",
            "fax_number": "956-233-6430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLY",
        "first_name": "KEITH",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8732T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Guadalupe Tillis, M.A. CCC-SLP
• Johanna Torres, M.S., LPC-S
• Rosa Maria Torres, SLP
• Samantha Yvonne Torres
• Silvia Patricia Trevino, LCSW
• Ufirst Imaging LLC
• Upward Quest, LLC
• Miguel Angel Uribe
• Arlene Elizabeth Valdez, P.A.
• Antonio Vasquez, OD

• Optometrist in Los Fresnos, TX
• Providers in Los Fresnos, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.