JOHN MAGNUS KETCHER (NPI# 1740594159) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740594159 |
| Entity Type | Individual |
| Full Name | JOHN MAGNUS KETCHER |
| Credential | O.D. |
| Practice Address |
1424 E Front St Tyler TX 75702 |
| Mailing Address |
Po Box 846098 Dallas TX 75284-6098 |
| Practice Telephone | 9035954144 |
| Mailing Telephone | 9033246400 |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2019-05-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 9394 | TX | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | 0618002629 | VA | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | 2022 | AZ | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 393764101 | 05 | |
| TX | MEDICARE RAIL ROAD | P02184376 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1424 E Front St, Tyler, TX 75702 | 9035954144 | |
| 2510 E Hunt Hwy Ste 26, San Tan Valley, AZ 851435208 | 9013384153 | 8443483379 |
| 400 Westhampton Sta, Richmond, VA 232263330 | 8042874200 | 8042874210 |
| Street Address |
1424 E FRONT ST |
| City | TYLER |
| State | TX |
| Zip Code | 75702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225037955 | Dehaven Eye Clinic Pa | Ophthalmology | 1424 E Front St, Tyler, TX 75702-8501 | 2005-07-15 |
| 1144608415 | Andrew D. Yoder | Optometrist | 1424 E Front St, Dehaven Eye Clinic, Pa, Tyler, TX 75702-8501 | 2015-05-07 |
| 1972657773 | Dehaven Eye Clinic Pa | Nurse Anesthetist, Certified Registered | 1424 E Front St, Tyler, TX 75702-8501 | 2007-01-22 |
| 1134163728 | Ron Junot | Registered Nurse | 1424 E Front St, Tyler, TX 75702-8501 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679116610 | Tiffiney Mcmakin | Nurse Practitioner | 810 E Houston St # 100, Tyler, TX 75702 | 2019-10-22 |
| 1659852507 | Krystal Gayle Lilley | Licensed Vocational Nurse | 100 E Ferguson St Ste 60a, Tyler, TX 75702 | 2018-08-28 |
| 1679029383 | Cynthia Lynn Kalawe | Physical Therapist | 100 E Ferguson, Suite 1204, Tyler, TX 75702 | 2016-09-01 |
| 1649623646 | Susan E Oxford | Social Worker | 13495 Frankston Highway, Tyler, TX 75702 | 2016-07-14 |
| 1053769281 | All Kidz Kan | Home Health | 2902 E Front St, Tyler, TX 75702 | 2016-05-27 |
| 1821415639 | Heather Mullins | Physical Therapy Assistant | 100 E. Ferguson Ste.1204, Tyler, TX 75702 | 2014-03-19 |
| 1346671336 | Dennis Keith Johnson | Dentist | 3081 Hwy. 31 East, Tyler, TX 75702 | 2013-12-02 |
| 1275882201 | Bobby Gibson | Counselor | 401 East Front Street, Ste 233, Tyler, TX 75702 | 2012-09-06 |
| 1144596792 | Tina Marie Borke | Clinical Neuropsychologist | 719 West Front St., Tyler, TX 75702 | 2012-03-28 |
| 1457629529 | James Whaley Rapp | Specialist/Technologist | 430 South Beckham Avenue, Trinity Mother Frances Sports Medicine, Tyler, TX 75702 | 2011-12-05 |
| Find all providers in zip 75702 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215335500 | Daniel & Max, LLC | Optometrist | 8988 S Broadway Ave, Suite 116, Tyler, TX 75703 | 2014-12-18 |
| 1093082257 | Mister Eyecare | Optometrist | 4601 S Broadway Ave Ste F22, Tyler, TX 75703-1320 | 2011-11-16 |
| 1801109525 | Jacob Colt West | Optometrist | 2209 Firestone Cir, Tyler, TX 75703-5870 | 2010-07-22 |
| 1740425164 | William Darrell Parker | Optometrist | 1105 Laurelwood Dr, Tyler, TX 75703-3927 | 2008-12-15 |
| 1023260569 | David Michael Johnson | Optometrist | 2756 S Broadway Ave, Tyler, TX 75701-5412 | 2008-10-15 |
| 1194859769 | Vantage Vision P.C. | Optometrist | 4601 S Broadway Ave, F22, Tyler, TX 75703-1307 | 2007-03-15 |
| 1033247598 | Larry M Chism PC | Optometrist | 136 Shelley Drive, Tyler, TX 75701 | 2007-02-28 |
| 1801923701 | Floyd Galloway Betts IIi | Optometrist | 136 Shelley Dr, Tyler, TX 75701-8723 | 2007-02-27 |
| 1679627301 | Eugene Bennett | Optometrist | 4824 S Broadway Ave, Tyler, TX 75703-1312 | 2007-01-22 |
| 1538223532 | Amy A Fisher | Optometrist | 2756 S Broadway Ave., Tyler, TX 75701-5412 | 2006-12-21 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.