Craig Alan Keller, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3221-35 Issued in WI

Practice address

301 Bay Park Square
Green Bay, WI 54304-5104

Phone

(920) 499-3511

NPI assigned

Jul 1, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Modern Eyes LTD.Group PAC ID 3274695267, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Modern Eyes LTD.

  • Optometrist
  • Green Bay, WI
  • NPI 1811132830
  Medicare reassignment Care Compare group NPD
• Shopko Stores Operating Co LLC

  • Community/Retail Pharmacy
  • Eau Claire, WI
  • NPI 1720034176
  NPD (past)

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310428800000",
    "number": "1780971499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BAY PARK SQUARE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045104",
            "telephone_number": "920-499-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BAY PARK SQUARE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045104",
            "telephone_number": "920-499-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "CRAIG",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3221-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Ann Keiler
• David Ralph Keim, MD
• Lori Ann Keisic Hummel, PT
• Keith'S Haircenter, LLC
• Taylor Kellam
• Jeffery W Keller, MD
• Kelsy B Kellermann, PA
• Miriah Kelley, RN
• Sharon A Kelley, PTA
• Jenny Lynn Kelly, APNP

• Optometrist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2011; 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.
• 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.