Provider Demographics
NPI:1124171798
Name:KEATOR, RANDALL DENISON II (OD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DENISON
Last Name:KEATOR
Suffix:II
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 1:140 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5725
Mailing Address - Country:US
Mailing Address - Phone:318-357-8194
Mailing Address - Fax:318-352-3145
Practice Address - Street 1:140 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5725
Practice Address - Country:US
Practice Address - Phone:318-357-8194
Practice Address - Fax:318-352-3145
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA778-078T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1198561Medicaid
LA1407895Medicaid
LA1198561Medicaid
LA1407895Medicaid
LA49234Medicare ID - Type Unspecified
LA5862720001Medicare NSC