Provider Demographics
NPI:1356400162
Name:KEEBLE, LEON III (OD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:KEEBLE
Suffix:III
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 1:101 E MORRISON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3382
Mailing Address - Country:US
Mailing Address - Phone:956-544-5735
Mailing Address - Fax:956-504-6798
Practice Address - Street 1:101 E MORRISON RD
Practice Address - Street 2:SUITE C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3382
Practice Address - Country:US
Practice Address - Phone:956-544-5735
Practice Address - Fax:956-504-6798
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4668TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019341901Medicaid
TXB0137508OtherDPS NUMBER
TXB0137508OtherDPS NUMBER
TX00E41UMedicare ID - Type Unspecified