Provider Demographics
NPI:1861441834
Name:GODWIN, KEEL M (OD)
Entity Type:Individual
Prefix:DR
First Name:KEEL
Middle Name:M
Last Name:GODWIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:KEEL
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4109 WAKE FOREST RD STE 10
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2510
Mailing Address - Country:US
Mailing Address - Phone:984-213-8863
Mailing Address - Fax:
Practice Address - Street 1:4109 WAKE FOREST RD STE 10
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2510
Practice Address - Country:US
Practice Address - Phone:984-213-8863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0922EOtherBCBS PIN
NC2471206Medicare PIN
NCU72677Medicare UPIN