Krysten L Avery, O.D.
Individual provider Active NPI Optometrist · North New Hyde Park, NY
NPI 1770670697 · NPPES record last updated Jun 7, 2021
Key facts
- NPI
- 1770670697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901004395 (MI)
- Practice address
- 1979 Marcus Ave Ste 206
North New Hyde Park, NY 11042-1002 - Phone
- (877) 506-0002
- NPI assigned
- Oct 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TPOP10 | FL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RX Optical Laboratories, Inc. | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TPOP10 | FL | |
| Optometrist | 152W00000X | 4901004395 | MI | Yes |
Addresses
Primary practice location
1979 Marcus Ave Ste 206
North New Hyde Park, NY 11042-1002
Mailing address
8256 Nadell St
Delton, MI 49046-8202
Phone (269) 267-7902
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770670697 | Medicaid | MI |
Other providers in North New Hyde Park, NY
All providers in North New Hyde Park, NY · Optometrist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.