Provider Demographics
NPI:1134120850
Name:RHODES, KRISTI LYN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYN
Last Name:RHODES
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:PO BOX 72802
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1031
Mailing Address - Country:US
Mailing Address - Phone:541-390-9667
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:29605 N CAVE CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-2360
Practice Address - Country:US
Practice Address - Phone:480-781-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2974T152W00000X
AZ1846152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ685453Medicaid
86-0884211OtherTAX ID
AZ2152408Medicare PIN
ORR119775Medicare PIN
ORP00930922Medicare Oscar/Certification
ORV00411Medicare UPIN