Provider Demographics
NPI:1336109115
Name:REMICK, KRISTY M (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:M
Last Name:REMICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:795 E 2ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-469-8773
Mailing Address - Fax:909-469-5228
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3899
Practice Address - Fax:909-469-8640
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7849TPG152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18467Medicare UPIN
CA410028219OtherMRRR
CAU18467Medicare UPIN
CASD0078492Medicaid