Provider Demographics
NPI:1366419798
Name:FARSON, KEITH ADRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ADRIAN
Last Name:FARSON
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 1:27724 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6653
Mailing Address - Country:US
Mailing Address - Phone:949-583-0422
Mailing Address - Fax:949-583-0417
Practice Address - Street 1:27724 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6653
Practice Address - Country:US
Practice Address - Phone:949-583-0422
Practice Address - Fax:949-583-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6913A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW0P6913AMedicare ID - Type Unspecified
CAU78397Medicare UPIN
CACB225056Medicare PIN