Provider Demographics
NPI:1518294883
Name:MOREJON, KRISTINE (LDO)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:MOREJON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E 9TH ST
Mailing Address - Street 2:SUITE# 2
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4260
Mailing Address - Country:US
Mailing Address - Phone:305-888-5166
Mailing Address - Fax:305-888-2289
Practice Address - Street 1:380 E 9TH ST
Practice Address - Street 2:SUITE# 2
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4260
Practice Address - Country:US
Practice Address - Phone:305-888-5166
Practice Address - Fax:305-888-2289
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 6081156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician