Provider Demographics
NPI:1194829382
Name:HINMAN, KRYSTA DANYELL (OD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTA
Middle Name:DANYELL
Last Name:HINMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRYSTA
Other - Middle Name:DANYELL
Other - Last Name:THOMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1140 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1048
Mailing Address - Country:US
Mailing Address - Phone:906-643-8689
Mailing Address - Fax:906-643-6716
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-8689
Practice Address - Fax:906-643-6716
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18846OtherSPECTERA
MI211469OtherCOLE MANAGED VISION