Provider Demographics
NPI:1275772055
Name:STAPLETON, KRISTA J (OD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:J
Last Name:STAPLETON
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 1:1735 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8928
Mailing Address - Country:US
Mailing Address - Phone:770-214-7310
Mailing Address - Fax:
Practice Address - Street 1:1735 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8928
Practice Address - Country:US
Practice Address - Phone:770-214-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist