Michael Allen Keith, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T 1320 Issued in TN

Practice address

119 Boone Ridge Dr
Suite 101
Johnson City, TN 37615-4998

Phone

(423) 283-7300

Fax

(423) 283-4729

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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 1

Specialty

Optometry

Education

Southern College of Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Keith Family Vision ClinicGroup PAC ID 8628012465, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Keith Family Vision Clinic

  • Optometrist
  • Johnson City, TN
  • NPI 1801927546
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063528446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 101",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-283-7300",
            "fax_number": "423-283-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 101",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-283-7300",
            "fax_number": "423-283-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITH",
        "first_name": "MICHAEL",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "T 1320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3597579",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Kazen, MD
• Shae Keane
• Kara Loven Keene, PA-C
• Keith Family Vision Clinic
• Gregory Lee Keith, O.D.
• Raquel Keithley, P.T. D.P.T P.C.S
• Krysten Kelch, LCSW
• Laura Ann Kellicut, MA
• Danny Kellum, LPC
• Cynthia Ann Kelly, L.C.S.W.

• Optometrist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.