NPI 1669430211 · live from the CMS NPI Registry
Kimberly R Bristow, OD
Optometrist in Newark, DE. National Provider Identifier 1669430211, active.
NPI record
| NPI | 1669430211 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 1 Centurian Dr, Suite 114, Newark, DE 19713 |
| Practice phone | 302-993-0722 |
| Mailing address | 103 Chesapeake Blvd, Ste C, Elkton, MD 21921 |
| Enumerated | May 3, 2006 |
| Last updated | September 22, 2011 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 13-0001241 (DE) |
| Optometrist | 152W00000X | TA1463 (MD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.