Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 35TH AVE SW
SEATTLE WA
98126-3228
US

IV. Provider business mailing address

7520 35TH AVE SW
SEATTLE WA
98126-3228
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-9600
  • Fax: 206-937-4088
Mailing address:
  • Phone: 206-937-9600
  • Fax: 206-937-4088

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: