Provider Demographics
NPI:1619298049
Name:LOVINGGOOD, KRISTINA (OD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:LOVINGGOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-5454
Mailing Address - Country:US
Mailing Address - Phone:334-874-7024
Mailing Address - Fax:334-874-7372
Practice Address - Street 1:801 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5454
Practice Address - Country:US
Practice Address - Phone:334-874-7024
Practice Address - Fax:334-874-7372
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C32152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKS-C32OtherALABAMA STATE LICENSE
AL6662030001Medicare NSC