MEDICARE: KEETON VISION CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1942392410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEETON VISION CARE, INC.

Provider Business Mailing Address
First Line	:	5901 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1613
Country	:	US
Telephone Number	:	636-498-2020
Fax Number	:	636-498-0500

Provider Business Practice Location Address
First Line	:	5901 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1613
Country	:	US
Telephone Number	:	636-498-2020
Fax Number	:	636-498-0500

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. RANDALL CHARLES KEETON
Credential	:
Telephone Number	:	636-498-2020

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/15/2008

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