Provider Demographics
NPI:1164704664
Name:KESHMIRI, SORAYA FRANCESCA (OD)
Entity Type:Individual
Prefix:DR
First Name:SORAYA
Middle Name:FRANCESCA
Last Name:KESHMIRI
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 1:1130 LAKE PLAZA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3595
Mailing Address - Country:US
Mailing Address - Phone:719-219-3819
Mailing Address - Fax:719-219-0411
Practice Address - Street 1:1130 LAKE PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3595
Practice Address - Country:US
Practice Address - Phone:719-219-3819
Practice Address - Fax:719-219-0411
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95086838Medicaid
COCOAAA2369Medicare PIN