Basic Information
| Provider Information | |||||||||
| NPI: | 1427060201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POINDEXTER | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1902 N SANDHILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283152382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106922020 | ||||||||
| FaxNumber: | 8003089356 | ||||||||
| Practice Location | |||||||||
| Address1: | 4811 FAYETTEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107393323 | ||||||||
| FaxNumber: | 9107396489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1773 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0926L | 01 | BCBS | OTHER | FH7000080 | 01 | FIRST CAROLINA CARE | OTHER | 410049407 | 01 | RAILROAD MEDICARE | OTHER | B0444 | 01 | MEDCOST | OTHER | 890926L | 05 | NC | MEDICAID |