Active NPI
Keston Micah Regis, O.D.
- Optometrist
- Forestville, MD
National Provider Identifier
1760816755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA2378
- Practice address
- 3309 Forestville PL
Forestville, MD 20747-4409 - Phone
- (301) 420-6610
- Fax
- (301) 735-0294
- NPI assigned
- Aug 26, 2013
- Last updated
- Jan 31, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA2378 | MD | Primary |
Addresses
Primary practice location
3309 Forestville PL
Forestville, MD 20747-4409
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD, DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA2378 | MD | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Visionworks, Inc. | Optometrist | Current | Accepting new patients |
| Visionworks Inc. | Past | Accepting new patients |
Locations
169 Jennifer Rd
Ste D
Annapolis, MD 21401
Phone (410) 224-0021
11110 Mall Cir
Waldorf, MD 20603
Phone (301) 705-8383
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517356800000",
"number": "1760816755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD STE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823970",
"telephone_number": "703-847-8899",
"fax_number": "866-795-4020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3309 FORESTVILLE PL",
"city": "FORESTVILLE",
"state": "MD",
"postal_code": "207474409",
"telephone_number": "301-420-6610",
"fax_number": "301-735-0294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REGIS",
"first_name": "KESTON",
"middle_name": "MICAH",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-26",
"last_updated": "2018-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA2378",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forestville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.