Provider Demographics
NPI:1730249426
Name:AMES, KEITH S (OD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:AMES
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 453
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0453
Mailing Address - Country:US
Mailing Address - Phone:740-774-2106
Mailing Address - Fax:740-774-2107
Practice Address - Street 1:612 CENTRAL CENTER
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-774-2106
Practice Address - Fax:740-774-2107
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3276T339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10115OtherCOORDINATED VISION CARE
OH0842744Medicaid
OH314399798027Medicaid
OH2200012OtherUHC
OH2200011OtherUHC
OH000000123256OtherBLUE CROSS BLUE SHIELD
OH314399798OtherTAX ID
OH0842744Medicaid
OH10115OtherCOORDINATED VISION CARE
OH039451001Medicare ID - Type UnspecifiedADMINISTAR FEDERAL (C)
OH000000123256OtherBLUE CROSS BLUE SHIELD
OH410011793Medicare ID - Type UnspecifiedRAILROAD
OHAM0709163Medicare ID - Type Unspecified
OH314399798027Medicaid