Provider Demographics
NPI:1649234295
Name:ELDER, KESHIA S (OD)
Entity Type:Individual
Prefix:DR
First Name:KESHIA
Middle Name:S
Last Name:ELDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:KEISHIA
Other - Middle Name:S
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT193TA757152W00000X
SC1188152WC0802X
MO2011023817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD11887Medicaid
MO1649234295Medicaid
AL9912034Medicaid
AL51543068OtherBCBS OF ALABAMA
MO1649234295Medicaid
ALU96311Medicare UPIN
SCD11887Medicaid