Provider Demographics
NPI:1700403169
Name:KRISTI K WEATHERLY OD LLC
Entity Type:Organization
Organization Name:KRISTI K WEATHERLY OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-544-9667
Mailing Address - Street 1:300 SCARLET PEAK CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4844
Mailing Address - Country:US
Mailing Address - Phone:724-544-9667
Mailing Address - Fax:
Practice Address - Street 1:744 SHENANGO RD STE 1
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-7111
Practice Address - Country:US
Practice Address - Phone:724-846-2020
Practice Address - Fax:724-846-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty