Provider Demographics
NPI:1306030408
Name:AMBROSE, KRISTY (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:CHMILEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:6515 GEORGE WASHINGTON MEM HWY STE 102
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2182
Practice Address - Country:US
Practice Address - Phone:757-369-6623
Practice Address - Fax:757-369-6627
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5708152W00000X
VA0618001729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist