=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306420674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY BULLINGTON OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2021
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 754 MAIN ST
-----------------------------------------------------
City | GARDENDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35071-2696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-631-7700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 GABLE DR
-----------------------------------------------------
City | CENTER POINT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35215-2868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-620-2753
-----------------------------------------------------
Fax | 616-383-0610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S-E85-TA-C33
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------