Keith Lyston, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008572 Issued in IL

Practice address

3300 Godfrey Rd
Godfrey, IL 62035-2558

Phone

(618) 466-8787

Fax

(618) 466-4703

NPI assigned

May 2, 2007

Last updated

Feb 19, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

University of Missouri St Louis - School of Optometry, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associated Vision Care, LTDGroup PAC ID 9133593460, 2 clinicians

Rose Optical, Inc.Group PAC ID 2961586805, 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Associated Vision Care, LTD

  dba Lakepointe Vision Care

  • Optometrist
  • O'Fallon, IL
  • NPI 1689370827
  Medicare reassignment Care Compare group NPD
• Rose Optical, Inc.

  • Optometrist
  • Godfrey, IL
  • NPI 1669444063
  Medicare reassignment Care Compare group NPD
• Blink LLC

  dba Lakepointe Vision Center

  • Optometrist
  • O'Fallon, IL
  • NPI 1629187208
  NPD
• Illini Optometric PC

  • Optometrist
  • Godfrey, IL
  • NPI 1780850032
  NPD

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1861614810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352558",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352558",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSTON",
        "first_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO3050",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lewis and Clark Community College (Lewis and Clark Community College Dental Hygiene Clinic)
• Ron Loflin, O.D.
• Sydnee Nicole Lollis
• Dana Renee Longmeyer, FNP
• Iona Lucas
• Emily Caroline Macias, COTA/L
• Ashley Marchello
• Emily Suzanne Martin, D.M.D.
• Norman Petronio Martinez Sr., DDS
• Bradley D Martinson, OD

• Optometrist in Godfrey, IL
• Providers in Godfrey, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.