Organization Active NPI

Keith Dennis OD PA

  • Optometrist
  • Round Rock, TX
National Provider Identifier
1821116104
Registry record updated Jun 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5964TG Issued in TX
Legal business name
KEITH DENNIS OD PA
Practice address
3107 S I H 35 Ste 780B
Round Rock, TX 78664-9352
Phone
(512) 310-9600
Fax
(512) 310-9266
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2013

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

Authorized official

Name
Dr. Keith Dennis, ODNPI 1558439463
Title
President
Phone
(512) 310-9600

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 5964TG TX Primary

Addresses

Primary practice location

3107 S I H 35 Ste 780B
Round Rock, TX 78664-9352

Mailing address

3107 S I H 35 Ste 780B
Round Rock, TX 78664-9352
Phone (512) 310-9600

Other names 1

  • Dr. Keith Dennis and Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051115001014 TX Part B Supplier - Clinic/Group Practice 0547289985 Receives reassigned benefits from 6 practitioners
Practice locations: Round Rock, TX

National Provider Directory

National Provider Directory

Locations

3107 S Interstate 35
Round Rock, TX 78664

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1821116104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3107 S I H 35 STE 780B",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786649352",
            "telephone_number": "512-310-9600",
            "fax_number": "512-310-9266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3107 S I H 35 STE 780B",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786649352",
            "telephone_number": "512-310-9600",
            "fax_number": "512-310-9266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH DENNIS OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-310-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5964TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Keith Dennis and Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.