Provider Demographics
NPI:1578058830
Name:BALDASSARI, KAITLYN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:ANN
Last Name:BALDASSARI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAITLYN
Other - Middle Name:ANN
Other - Last Name:HYLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4801 GARDEN SPRING LN APT 306
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2576
Mailing Address - Country:US
Mailing Address - Phone:585-747-7058
Mailing Address - Fax:
Practice Address - Street 1:2400 SHEILA LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2040
Practice Address - Country:US
Practice Address - Phone:804-433-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist