Organization Active NPI

Steven J Keith OD PC

  • Optometrist
  • Woodstock, GA
National Provider Identifier
1588949846
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1504 Issued in GA
Legal business name
STEVEN J KEITH OD PC
Doing business as
Towne Lake Eye Associates
Practice address
1010 Wyngate Pkwy Ste 201
Woodstock, GA 30189-6990
Phone
(770) 926-2858
Fax
(770) 926-5106
NPI assigned
Oct 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Authorized official

Name
Steven J Keith, ODNPI 1144222605
Title
Pres/Ceo
Phone
(770) 926-2858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1504 GA Primary

Addresses

Primary practice location

1010 Wyngate Pkwy Ste 201
Woodstock, GA 30189-6990

Mailing address

1010 Wyngate Pkwy Ste 201
Woodstock, GA 30189-6990
Phone (770) 926-2858

Other names 1

  • Towne Lake Eye Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190529002136 GA Part B Supplier - Clinic/Group Practice 9335482645 Receives reassigned benefits from 4 practitioners
Practice locations: Woodstock, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2341633Towne Lake Eye Associates1010 Wyngate Parkway, Suite 201, Woodstock, GA 30189Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory

Locations

1010 Wyngate Pkwy
Ste 201
Woodstock, GA 30189
Phone (770) 926-2858

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1588949846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 WYNGATE PKWY STE 201",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896990",
            "telephone_number": "770-926-2858",
            "fax_number": "770-926-5106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 WYNGATE PKWY STE 201",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896990",
            "telephone_number": "770-926-2858",
            "fax_number": "770-926-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN J KEITH OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "KEITH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRES/CEO",
        "authorized_official_telephone_number": "770-926-2858",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Towne Lake Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.