Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. BERT EDMOND KETCHUM III OD
NPI 1174107866
Optometrist in Fpo, AP

Q: What is Bert Ketchum's NPI number?

The NPI number for Bert Ketchum is 1174107866. It was assigned to this individual provider in the NPPES registry on May 8, 2021. The provider is also known as Trey Ketchum.

Q: What is Bert Ketchum's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Bert Ketchum was last updated on August 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 35 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 08, 2021PECOS Enrolled

PSC 475 BOX 1, FPO, AP 96350(757) 458-2998 Get Directions Write a Review

NPPES record last updated: August 25, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Aug 25, 2026, Jun 6, 2024, Jun 17, 2021 and 1 more (4 updates tracked since 2021).

On this page

About Dr. Bert Edmond Ketchum Iii Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BERT EDMOND KETCHUM III OD (NPI 1174107866) is an individual optometrist in Fpo, AP, licensed in Virginia (0618003037) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174107866

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameDR. BERT EDMOND KETCHUM IIICredential: OD

Location AddressPSC 475 BOX 1Fpo, AP 96350-1200

Mailing AddressPsc 475 Box 1Fpo, AP 96350-1200

Phone(757) 458-2998

Sole ProprietorNo

Enumeration DateMay 8, 2021

Last NPPES UpdateAugust 25, 20264 updates tracked since enumeration

NPPES CertifiedAugust 25, 2026

✔ NPI 1174107866 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in VA · 0618003037

Definition

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.

Other Names 1

Other Name (5)Trey Ketchum

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Bert Edmond Ketchum Iii Od is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANTHONY JAMES MARIN D.D.S.

Dentist (Endodontics)

PSC 475 BOX 1
FPO, AP 96350

(315) 243-5069

JASON PAUL JENSEN OTR/L, CHT

Occupational Therapist

PSC 475 BOX 1
FPO, AP 96350

(315) 243-5348

ANDREA L HAYES MSH, RD/RN

Dietitian, Registered

PSC 475 BOX 1
FPO, AP 96350

(315) 243-8658

MR. SAMUEL FOSTER OT

Occupational Therapist

PSC 475 BOX 1
FPO, AP 96350

(315) 253-4562

KIRSTEN LEANNE SANDOVAL

Occupational Therapist

PSC 475 BOX 1
FPO, AP 96350

(818) 277-9111

DR. MIRIAM BEHPOUR DMD

Dentist (General Practice)

PSC 475 BOX 1
FPO, AP 96350

(315) 243-7144

MR. SEBASTIAN NMN STACHOWICZ CRNA

Nurse Anesthetist, Certified Registered

PSC 475 BOX 1
FPO, AP 96350

(619) 532-6400

PHILIP DEAN PETERSON MD

Pathology (Anatomic Pathology & Clinical Pathology)

PSC 475 BOX 1
FPO, AP 96350

(315) 243-8560

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bert Ketchum's NPI number?

The NPI number for Bert Ketchum is 1174107866. It was assigned to this individual provider in the NPPES registry on May 8, 2021. The provider is also known as Trey Ketchum.

Where is Bert Ketchum located?

Bert Ketchum practices at Psc 475 Box 1, Fpo, AP 96350. The listed phone number is (757) 458-2998.

What is Bert Ketchum's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Bert Ketchum enrolled in Medicare?

Yes. Bert Ketchum is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Bert Ketchum was last updated on August 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 35 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.