Provider Demographics
NPI:1518964709
Name:VOTENS, KEITH ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ERIC
Last Name:VOTENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7552 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2307
Mailing Address - Country:US
Mailing Address - Phone:520-744-1711
Mailing Address - Fax:
Practice Address - Street 1:7552 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-744-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01156152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144649OtherBCBS
AZAZ0902810OtherBCBS
AZWCKGLMedicaid
Z144649Medicare PIN
AZWCKGLMedicaid
AZAZ0902810OtherBCBS
AZZ144649OtherBCBS