Krystal Vision Center Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG000225 Issued in PA

Legal business name

KRYSTAL VISION CENTER INC

Practice address

6533 Roosevelt Blvd
Philadelphia, PA 19149-2918

Phone

(215) 744-6727

NPI assigned

Jul 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Krystal T Nguyen, O.D.NPI 1538109590

Title

President

Phone

(215) 744-6727

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Krystal T Nguyen, OD

  • Optometrist
  • Philadelphia, PA
  • NPI 1538109590
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1609806777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6533 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492918",
            "telephone_number": "215-744-6727",
            "fax_number": "215-744-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492918",
            "telephone_number": "215-744-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRYSTAL VISION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-744-6727",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1626663",
            "identifier": "HIGHMARK",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "3548372",
            "identifier": "AETNA",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "2308658000",
            "identifier": "IBC",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Florence Gentile Kruse, MD
• Morgan Krush
• Adam Mika Kruszewski, MD
• Jacqeulyn Ann Krwawicz, BSW
• Meri Kryss, MD
• Kayla Danielle Krystek, CRNP
• Tatiana Kryzhanovskaya-Lutsik, LPC
• Regina Theresa Krzeminski, PHARMD
• KSB Dental LLC
• Bon Suk Ku, MD

• Optometrist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.