Active NPI
Bob R. Keathley
- Optician
- Tulsa, OK
National Provider Identifier
1568675452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 020779
- Practice address
- 6025 South Sheridan
Tulsa, OK 74145 - Phone
- (918) 494-2671
- Fax
- (918) 496-1993
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 020779 | OK | Primary |
Addresses
Primary practice location
6025 South Sheridan
Tulsa, OK 74145
Mailing address
6025 South Sheridan
Tulsa, OK 74145
Phone (918) 494-2671
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020779 | OK | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bob Keathley Opticians LLC | Optician | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568675452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6025 SOUTH SHERIDAN",
"city": "TULSA",
"state": "OK",
"postal_code": "74145",
"telephone_number": "918-494-2671",
"fax_number": "918-496-1993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6025 SOUTH SHERIDAN",
"city": "TULSA",
"state": "OK",
"postal_code": "74145",
"telephone_number": "918-494-2671",
"fax_number": "918-496-1993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEATHLEY",
"first_name": "BOB",
"middle_name": "R.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "OK",
"license": "020779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.