Provider Demographics
NPI:1225023310
Name:CAUSBY, KRISTEL WHITLEY (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:WHITLEY
Last Name:CAUSBY
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 1:486 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8026
Mailing Address - Country:US
Mailing Address - Phone:828-452-5816
Mailing Address - Fax:828-452-0373
Practice Address - Street 1:486 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8026
Practice Address - Country:US
Practice Address - Phone:828-452-5816
Practice Address - Fax:828-452-0373
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890909FMedicaid
2469931Medicare PIN
U61730Medicare UPIN
NC890909FMedicaid