Provider Demographics
NPI:1972490746
Name:THOMAS, KELSEY ALEXANDRA (OD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:ALEXANDRA
Last Name:THOMAS
Suffix:
Gender:X
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4871 TOWN CENTER PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8310
Mailing Address - Country:US
Mailing Address - Phone:904-913-1082
Mailing Address - Fax:
Practice Address - Street 1:4871 TOWN CENTER PKWY STE 5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8310
Practice Address - Country:US
Practice Address - Phone:904-913-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist