Provider Demographics
NPI:1114189032
Name:KEITH J. ERMIS OD PC
Entity Type:Organization
Organization Name:KEITH J. ERMIS OD PC
Other - Org Name:THE FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERMIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:979-532-0805
Mailing Address - Street 1:1120 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3128
Mailing Address - Country:US
Mailing Address - Phone:979-532-0805
Mailing Address - Fax:979-532-2084
Practice Address - Street 1:1120 N FULTON ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3128
Practice Address - Country:US
Practice Address - Phone:979-532-0805
Practice Address - Fax:979-532-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124299-01Medicaid
TXE74UMedicare PIN
TX1069590001Medicare NSC
TXU01146Medicare UPIN