Provider Demographics
NPI:1073946398
Name:WITT, CRISTY L (OD)
Entity Type:Individual
Prefix:DR
First Name:CRISTY
Middle Name:L
Last Name:WITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15159 E COLFAX AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-5707
Mailing Address - Country:US
Mailing Address - Phone:303-341-5437
Mailing Address - Fax:719-542-0425
Practice Address - Street 1:15159 E COLFAX AVE UNIT B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5707
Practice Address - Country:US
Practice Address - Phone:303-341-5437
Practice Address - Fax:719-542-0425
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003056152W00000X
MDTA2363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist