Provider Demographics
NPI:1043277577
Name:KERESTAN GARBIG, KRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:KERESTAN GARBIG
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 1:1400 GLORIA TERRELL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41076-9188
Mailing Address - Country:US
Mailing Address - Phone:859-441-3400
Mailing Address - Fax:859-572-4822
Practice Address - Street 1:1400 GLORIA TERRELL DR
Practice Address - Street 2:SUITE H
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076-9188
Practice Address - Country:US
Practice Address - Phone:859-441-3400
Practice Address - Fax:859-572-4822
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1196DT152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1043277577OtherMEDICARE RAILROAD RETIREMENT BOARD
KY77011963Medicaid
KY000000184813OtherANTHEM PIN #
KY0004324518OtherAETNA
KY0470570001Medicare NSC
KY1043277577OtherMEDICARE RAILROAD RETIREMENT BOARD