Provider Demographics
NPI:1407142086
Name:KIDD, AYESHA (OD, FAAO)
Entity Type:Individual
Prefix:MS
First Name:AYESHA
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2020
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533
Mailing Address - Country:US
Mailing Address - Phone:251-990-3937
Mailing Address - Fax:251-990-9990
Practice Address - Street 1:411 NORTH SECTION STREET
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-3937
Practice Address - Fax:251-990-9990
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C61-TA-904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist