Provider Demographics
NPI:1942794490
Name:KEYES, KAITLIN ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:KEYES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23079 COURTHOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:ACCOMAC
Mailing Address - State:VA
Mailing Address - Zip Code:23301-1505
Mailing Address - Country:US
Mailing Address - Phone:757-787-7040
Mailing Address - Fax:757-787-2886
Practice Address - Street 1:23079 COURTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:ACCOMAC
Practice Address - State:VA
Practice Address - Zip Code:23301-1505
Practice Address - Country:US
Practice Address - Phone:757-787-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942794490Medicaid
VA1174546196Medicaid
VA1942794490OtherOPTOMETRY