Provider Demographics
NPI:1770108573
Name:GRAFFAGNINO, KELSIE MORGAN (OD)
Entity type:Individual
Prefix:MRS
First Name:KELSIE
Middle Name:MORGAN
Last Name:GRAFFAGNINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:KELSIE
Other - Middle Name:MORGAN
Other - Last Name:GRAFFAGNINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:3431 COLONNADE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3338
Practice Address - Country:US
Practice Address - Phone:205-967-2020
Practice Address - Fax:205-967-7120
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E48-TA-B92152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist