Provider Demographics
NPI:1598758781
Name:MAY, KRISTOPHER ALAN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:ALAN
Last Name:MAY
Suffix:
Gender:M
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:PO BOX 486
Mailing Address - Street 2:412 CENTRAL AVENUE
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-0486
Mailing Address - Country:US
Mailing Address - Phone:662-622-5173
Mailing Address - Fax:662-622-5590
Practice Address - Street 1:412 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-3843
Practice Address - Country:US
Practice Address - Phone:662-622-5173
Practice Address - Fax:662-622-5590
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2302152W00000X
MS697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2302OtherOD
TN3945526Medicaid
11230062OtherCAQH
MS00880194Medicaid
MS697OtherMS LICENSE
MM1088598OtherDEA
MS697OtherMS LICENSE
11230062OtherCAQH
TN3945327Medicare ID - Type Unspecified
TN3945526Medicaid