Active NPI
Luther B Keller, OD
- Optometrist
- Osceola, AR
National Provider Identifier
1811998032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2218
- Practice address
- 102 Plantation Dr.
Osceola, AR 72370 - Phone
- (870) 563-3596
- Fax
- (870) 563-1239
- NPI assigned
- Aug 10, 2005
- Last updated
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2218 | AR | Primary |
| Optometrist | 152W00000X | OP1100056 | AR |
Addresses
Primary practice location
102 Plantation Dr.
Osceola, AR 72370
Mailing address
102 Plantation Dr.
Osceola, AR 72370
Phone (870) 563-3596
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103479722 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OP1100056 | AR | MD | Optometrist |
| 2218 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1811998032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 PLANTATION DR.",
"city": "OSCEOLA",
"state": "AR",
"postal_code": "72370",
"telephone_number": "870-563-3596",
"fax_number": "870-563-1239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 PLANTATION DR.",
"city": "OSCEOLA",
"state": "AR",
"postal_code": "72370",
"telephone_number": "870-563-3596",
"fax_number": "870-563-1239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "LUTHER",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AR",
"license": "2218",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AR",
"license": "OP1100056",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103479722",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Osceola, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.