Healthcare Provider Details

I. General information

NPI: 1073754511
Provider Name (Legal Business Name): KESHIA CASIMIR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SW 41ST ST.
RENTON WA
98057
US

IV. Provider business mailing address

3025 112TH AVE NE SUITE 200
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 425-255-4250
  • Fax: 425-271-9234
Mailing address:
  • Phone: 800-925-2020
  • Fax: 425-450-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.010185
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60307982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: