Provider Demographics
NPI:1942392410
Name:KEETON VISION CARE, INC.
Entity Type:Organization
Organization Name:KEETON VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-498-2020
Mailing Address - Street 1:5901 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1613
Mailing Address - Country:US
Mailing Address - Phone:636-498-2020
Mailing Address - Fax:636-498-0500
Practice Address - Street 1:5901 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1613
Practice Address - Country:US
Practice Address - Phone:636-498-2020
Practice Address - Fax:636-498-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001497Medicare PIN
MO1246880001Medicare NSC