Provider Demographics
NPI:1114099405
Name:KESHAVA, CHRISTINA HUTH (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:HUTH
Last Name:KESHAVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9145
Mailing Address - Country:US
Mailing Address - Phone:802-747-6359
Mailing Address - Fax:
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 15
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-775-0038
Practice Address - Fax:802-747-0602
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0000347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist