Provider Demographics
NPI:1760537476
Name:ERMIS, KEITH J (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:ERMIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1602 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3065
Mailing Address - Country:US
Mailing Address - Phone:979-532-0805
Mailing Address - Fax:979-532-2084
Practice Address - Street 1:1602 N FULTON ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3065
Practice Address - Country:US
Practice Address - Phone:979-532-0805
Practice Address - Fax:979-532-2084
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3779TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112429904Medicaid
TX112429904Medicaid
TXU01146Medicare UPIN
TX1069590001Medicare NSC