Provider Demographics
NPI:1427060201
Name:POINDEXTER, KEITH P (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:P
Last Name:POINDEXTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N SANDHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2382
Mailing Address - Country:US
Mailing Address - Phone:910-692-2020
Mailing Address - Fax:800-308-9356
Practice Address - Street 1:4811 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2111
Practice Address - Country:US
Practice Address - Phone:910-739-3323
Practice Address - Fax:910-739-6489
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0926LOtherBCBS
FH7000080OtherFIRST CAROLINA CARE
410049407OtherRAILROAD MEDICARE
B0444OtherMEDCOST
NC890926LMedicaid
B0444OtherMEDCOST
0926LOtherBCBS