Provider Demographics
NPI:1265873509
Name:XU, KEPING (OD)
Entity type:Individual
Prefix:
First Name:KEPING
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 PLEASANT HILL RD STE 125
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2308
Mailing Address - Country:US
Mailing Address - Phone:770-497-8100
Mailing Address - Fax:
Practice Address - Street 1:2205 PLEASANT HILL RD STE 125
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2308
Practice Address - Country:US
Practice Address - Phone:770-497-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist