Provider Demographics
NPI:1205935111
Name:KEATING, BILL C (OD)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:C
Last Name:KEATING
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:PO BOX 10957
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0957
Mailing Address - Country:US
Mailing Address - Phone:479-452-1580
Mailing Address - Fax:479-452-6910
Practice Address - Street 1:8301 ROGERS AVENUE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-452-1580
Practice Address - Fax:479-452-6910
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132180722Medicaid
49256Medicare ID - Type Unspecified
AR132180722Medicaid