Provider Demographics
NPI:1639139397
Name:RICHWINE, KRISTIN NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE
Last Name:RICHWINE
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 1:8316 MEDICAL PLAZA DR STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6704
Mailing Address - Country:US
Mailing Address - Phone:704-547-1551
Mailing Address - Fax:
Practice Address - Street 1:8316 MEDICAL PLAZA DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6704
Practice Address - Country:US
Practice Address - Phone:704-547-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093KTOtherBCBS
NC89093KTMedicaid
NC2472159AMedicare PIN
NC89093KTMedicaid
NC2472159Medicare PIN
NC0485250001Medicare NSC