Provider Demographics
NPI:1073946638
Name:KEKAHUNA, VIRGINIA (OD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:KEKAHUNA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:VIRGINIA
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4217 BENNER ROAD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640
Mailing Address - Country:US
Mailing Address - Phone:512-430-4350
Mailing Address - Fax:512-430-4393
Practice Address - Street 1:4217 BENNER ROAD
Practice Address - Street 2:SUITE 450
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640
Practice Address - Country:US
Practice Address - Phone:979-571-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8242T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316051YVBLMedicare UPIN