Provider Demographics
NPI:1003128935
Name:DEAN, KRISTY MAY (OD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MAY
Last Name:DEAN
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 1:1284 DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8795
Mailing Address - Country:US
Mailing Address - Phone:607-257-1066
Mailing Address - Fax:607-257-1378
Practice Address - Street 1:1284 DRYDEN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8795
Practice Address - Country:US
Practice Address - Phone:607-257-1066
Practice Address - Fax:607-257-1378
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56007594152W00000X
NYTUV007594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist