Provider Demographics
NPI:1386626430
Name:WASHBURN, KRISTI RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:RENEE
Last Name:WASHBURN
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 1:1520 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4922
Mailing Address - Country:US
Mailing Address - Phone:903-885-7999
Mailing Address - Fax:903-439-6322
Practice Address - Street 1:1520 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4922
Practice Address - Country:US
Practice Address - Phone:903-885-7999
Practice Address - Fax:903-439-6322
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5932TG174400000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0930075-01Medicaid
TXP08820K04Medicaid
TX4175280001Medicare NSC
TX00R84ZMedicare PIN
TXP08820K04Medicaid
TX0930075-01Medicaid
TX4175280001Medicare NSC