Eric Lee Ketchum, O.D.
Individual provider Active NPI Optometrist · Emory, TX
NPI 1275820649 · NPPES record last updated Jul 6, 2011
Key facts
- NPI
- 1275820649
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 7878T (TX)
- Practice address
- 886 E Lennon Dr Ste 102
Emory, TX 75440-3216 - Phone
- (903) 474-9090
- Fax
- (903) 474-9111
- NPI assigned
- Jul 6, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Houston - College of Optometry, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
886 E Lennon Dr
Emory, TX 75440-3216
Phone (903) 474-9090
Merit-based Incentive Payment System (MIPS)
- Final score
- 65.83 of 100
- Quality
- 31.67
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 74 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110829000545 | TX | Practitioner - Optometry | 4486824505 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7878 | TX | MD | Chiropractor |
| 7878T | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elk Vision Holdings LLC | Optometrist | Current |
Accepting new patients |
Locations
886 E Lennon Dr
Ste 102
Emory, TX 75440
Phone (903) 474-9090
Interoperability endpoints
- drketchum@emoryeyecare.eyefinity-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 7878T | TX | Yes |
Addresses
Primary practice location
886 E Lennon Dr Ste 102
Emory, TX 75440-3216
Mailing address
886 E Lennon Dr Ste 102
Emory, TX 75440-3216
Phone (903) 474-9090
Other providers in Emory, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.