Provider Demographics
NPI:1235430992
Name:JAMES, KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 COLUMBIA PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1876
Mailing Address - Country:US
Mailing Address - Phone:571-441-0041
Mailing Address - Fax:
Practice Address - Street 1:6828 SPRINGFIELD MALL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1720
Practice Address - Country:US
Practice Address - Phone:703-971-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002556152W00000X
390200000X
MDTA-2497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program