Provider Demographics
NPI:1568420214
Name:DAVIS, KRISTI K (OD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:KAY
Other - Last Name:PATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2770 EUREKA WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0252
Mailing Address - Country:US
Mailing Address - Phone:530-222-7271
Mailing Address - Fax:530-222-5282
Practice Address - Street 1:2770 EUREKA WAY STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0252
Practice Address - Country:US
Practice Address - Phone:530-222-7271
Practice Address - Fax:530-351-7046
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11942T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119420Medicaid
CASD0119421Medicare PIN
CASD0119420Medicaid
CA4927390001Medicare NSC