Provider Demographics
NPI:1518023654
Name:MORRIS, KRISTINA (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:MORRIS
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 1:4619 W RICHLAND PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9776
Mailing Address - Country:US
Mailing Address - Phone:812-332-3937
Mailing Address - Fax:812-336-7697
Practice Address - Street 1:4619 W RICHLAND PLAZA DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9776
Practice Address - Country:US
Practice Address - Phone:812-332-3937
Practice Address - Fax:812-336-7697
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002665B152WP0200X, 152WV0400X, 152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200044260AMedicaid
IN4934250001Medicare NSC
IN200044260AMedicaid
INM400033255Medicare PIN