NPIMap

Organization Active NPI

Keller Crymes & Demarco LLC

Doing business as Keller Optical

  • Eyewear Supplier
  • Athens, GA
National Provider Identifier
1790907277
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
BT-085849 Issued in GA
Legal business name
KELLER CRYMES & DEMARCO LLC
Doing business as
Keller Optical
Practice address
105 Trinity PL.
Athens, GA 30607-2112
Phone
(706) 549-9993
Fax
(706) 549-4047
NPI assigned
May 3, 2007
Last updated
Aug 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Authorized official

Name
Dr. Walter Augustus Sams IV, MDNPI 1417179268
Title
Physician
Phone
(706) 549-9993

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Eyewear Supplier 332H00000X BT-085849 GA Primary

Addresses

Primary practice location

105 Trinity PL.
Athens, GA 30607-2112

Mailing address

105 Trinity Place
Athens, GA 30607-2112
Phone (706) 549-9993

Other names 1

  • Keller Optical Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address DIRECT@athenseyedoctorssurgeonsathensga.compulinkdirect.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930068976 GA DME Supplier - Physician - OphthalmologyDME Supplier - Optician 3971591132 Practice locations: Athens, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Keller Crymes & Demarco LLC105 Trinity PL, Athens, GA 30607-2112(706) 286-8227 Ocular Prostheses|Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Oct 2, 2000

National Provider Directory

National Provider Directory
Tax ID family
Keller Crymes Demarco LL2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1010 Prince Ave
Ste 110
Athens, GA 30606

1586 Mars Hill Rd
Watkinsville, GA 30677

72 W Candler St
Winder, GA 30680
Phone (770) 867-1913

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1790907277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 TRINITY PLACE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306072112",
            "telephone_number": "706-549-9993",
            "fax_number": "706-549-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 TRINITY PL.",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306072112",
            "telephone_number": "706-549-9993",
            "fax_number": "706-549-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLER CRYMES & DEMARCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A",
        "authorized_official_last_name": "SAMS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "AUGUSTUS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "706-549-9993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "GA",
            "license": "BT-085849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DIRECT@athenseyedoctorssurgeonsathensga.compulinkdirect.com",
            "affiliation": "N",
            "endpointDescription": "CCD",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "105 Trinity Pl.",
            "city": "Athens",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306072112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Keller Optical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Keller Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.