Provider Demographics
NPI:1740237478
Name:TAORMINA, KRISTI ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ANN
Last Name:TAORMINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:WATCHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7631 RIVERS AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-863-1970
Mailing Address - Fax:843-863-8385
Practice Address - Street 1:7631 RIVERS AVE.
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-863-1970
Practice Address - Fax:843-863-8385
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV06810Medicare UPIN