Provider Demographics
NPI:1306420674
Name:BULLINGTON, KELSEY (OD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:BULLINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:MCCLUSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:709 GABLE DR
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-2868
Mailing Address - Country:US
Mailing Address - Phone:256-620-2753
Mailing Address - Fax:616-383-0610
Practice Address - Street 1:754 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2696
Practice Address - Country:US
Practice Address - Phone:205-631-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E85-TA-C33152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS-E85-TCA-C33OtherSTATE LICENSE