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

Active since May 08, 2021PECOS Enrolled
USNH/USNMRTC GUANTANAMO BAY, CUBA, PSC 1005 BOX 110185, FPO, AA 34009(757) 458-2998 Get Directions Write a Review

NPPES record last updated: June 6, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 6, 2024, Jun 17, 2021, May 8, 2021 (3 updates tracked since 2021).

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, AA, 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 AddressUSNH/USNMRTC GUANTANAMO BAY, CUBA, PSC 1005 BOX 110185Fpo, AA 34009
Mailing AddressUsnh/usnmrtc Guantanamo Bay, Cuba, Psc 1005 Box 110185Fpo, AA 34009
Phone(757) 458-2998
Sole ProprietorNo
Enumeration DateMay 8, 2021
Last NPPES UpdateJune 6, 20243 updates tracked since enumeration
NPPES CertifiedAugust 10, 2021
✔ 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.

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 Usnh/Usnmrtc Guantanamo Bay, Cuba Psc 1005 Box 110185, Fpo, AA 34009. 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 June 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.