Dr. Anwi Etame OD Professional Optometric Corporation

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DR. ANWI ETAME OD PROFESSIONAL OPTOMETRIC CORPORATION

Doing business as

Keller Premier Eye Care

Practice address

900 S Main St Ste 351
Keller, TX 76248-7024

Phone

(817) 527-9800

Fax

(817) 993-4033

NPI assigned

Oct 9, 2019

Organization subpart

No

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

Authorized official

Name

Anwi Ngando Etame, O.D.NPI 1831399591

Title

O.D./ Optometrist

Phone

(503) 809-9624

Specialties & licenses 1

Addresses

Other names 1

• Keller Premier Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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.

• Anwi Etame, OD

  • Optometrist
  • Rock Island, IL
  • NPI 1831399591

  TX

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571443200000",
    "number": "1881236008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 CEDAR RIDGE DR",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762488355",
            "telephone_number": "503-809-9624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S MAIN ST STE 351",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762487024",
            "telephone_number": "817-527-9800",
            "fax_number": "817-993-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ANWI ETAME OD PROFESSIONAL OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-19",
        "status": "A",
        "authorized_official_last_name": "ETAME",
        "authorized_official_first_name": "ANWI",
        "authorized_official_middle_name": "NGANDO",
        "authorized_official_title_or_position": "O.D./ OPTOMETRIST",
        "authorized_official_telephone_number": "503-809-9624",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keller Premier Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyler Dorshorst, DC
• Kyra Dougherty
• Lauren M Doughty, RBT
• Laura Jane Downey, RN,FNP-BC
• Dr Rami Turner DO PLLC
• Dr. Buie & Associates, PC
• Kaitlynn Ann Drewes
• Natalie Driver
• Alyssa Dudley
• Tommy Brent Duncan, MD

• Clinic/Center in Keller, TX
• Providers in Keller, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2019; 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.