Provider Demographics
NPI:1538479365
Name:PETTY, KRISTINA J (OD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:J
Last Name:PETTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:J
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:561 KEYSTONE AVE # 143
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4304
Mailing Address - Country:US
Mailing Address - Phone:775-338-0883
Mailing Address - Fax:
Practice Address - Street 1:415 US HIGHWAY 95A S
Practice Address - Street 2:UNIT A
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9261
Practice Address - Country:US
Practice Address - Phone:775-575-5700
Practice Address - Fax:775-575-5702
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist