Provider Demographics
NPI:1265685879
Name:URBAN, KRISTIN BLEVINS (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BLEVINS
Last Name:URBAN
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 1:510 N ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-3604
Mailing Address - Country:US
Mailing Address - Phone:361-275-5743
Mailing Address - Fax:361-275-6432
Practice Address - Street 1:510 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-3604
Practice Address - Country:US
Practice Address - Phone:361-275-5743
Practice Address - Fax:361-275-6432
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7266TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist