Provider Demographics
NPI:1689666968
Name:CARRINGTON-HELLIER, CRYSTAL M (OD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:CARRINGTON-HELLIER
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:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:906-932-4585
Practice Address - Street 1:E6112 E BLUFFVIEW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9367
Practice Address - Country:US
Practice Address - Phone:906-932-1436
Practice Address - Fax:906-932-0644
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38626500OtherWISCONSIN MEDICAID
MI4733142Medicaid
MI900B710160OtherMICHIGAN BLUE CROSS BLUE
MI900B710160OtherMICHIGAN BLUE CROSS BLUE
MIU98783Medicare UPIN