Keith J. Castleton, O.D.
Individual provider Active NPI Optometrist · Salt Lake City, UT
NPI 1730168071 · NPPES record last updated Dec 19, 2024
Key facts
- NPI
- 1730168071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1475 (AZ)
- Practice address
- 660 S 200 E Ste 250
Salt Lake City, UT 84111-3846 - Phone
- (801) 359-2256
- NPI assigned
- Jan 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Confederated Tribes of the Goshute Reservation
Practice addresses (Care Compare)
660 S 200
Salt Lake City, UT 84111-3846
660 S 200 E
Salt Lake, UT 84111-3846
Phone (801) 395-2256
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, 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 |
|---|---|---|---|---|
| I20111022000072 | UT | Practitioner - Optometry | 0840345260 | Reassigns benefits to 2 organizations |
| I20220221001031 | TX | Practitioner - Optometry | 0840345260 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 885 | NV | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Confederated Tribes of the Goshute Reservation | Current |
Accepting new patients | |
| Confederated Tribes of the Goshute Reservation | Current |
Accepting new patients | |
| Ma Bo Inc | Current | Accepting new patients | |
| Luxe Vision Utah LLC | Optometrist | Current |
Accepting new patients |
Locations
195 Tribal Center Rd
Ibapah, UT 84034
Phone (435) 234-1302
466 E 500 S
Ste 200
Salt Lake Cty, UT 84111
Phone (801) 485-5055
8734 S 700 E
#240
Sandy, UT 84070
Phone (801) 610-9136
8734 S 700 E
Ste 240
Sandy, UT 84070
Phone (801) 448-7385
660 S 200 E
Slc, UT 84111
Phone (801) 355-1528
660 S 200 E
Ste 250
Slc, UT 84111
Phone (801) 395-2256
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5350538-9934 | UT | |
| Optometrist | 152W00000X | 1475 | AZ | Yes |
Addresses
Primary practice location
660 S 200 E Ste 250
Salt Lake City, UT 84111-3846
Mailing address
5961 S Los Altos Pkwy Ste 101
Ste 101
Sparks, NV 89436-2501
Phone (775) 359-2020
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2024. 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.