Provider Demographics
NPI:1689041048
Name:RAESS, KRISTI (OD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:RAESS
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 1:7001 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9643
Mailing Address - Country:US
Mailing Address - Phone:919-861-9178
Mailing Address - Fax:
Practice Address - Street 1:7001 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9643
Practice Address - Country:US
Practice Address - Phone:919-861-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2432OtherSTATE LICENSE