Provider Demographics
NPI:1760441042
Name:KRITHIVAS, KRISHNA (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:KRITHIVAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4419
Mailing Address - Country:US
Mailing Address - Phone:207-799-3031
Mailing Address - Fax:207-799-9005
Practice Address - Street 1:743 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4419
Practice Address - Country:US
Practice Address - Phone:207-799-3031
Practice Address - Fax:207-799-9005
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT 866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1760441042OtherKRISHNA KRITHIVAS INDIVIDUAL NPI
ME1073773487OtherGROUP NPI
MEDP3562Medicare PIN
ME1073773487OtherGROUP NPI
ME1760441042OtherKRISHNA KRITHIVAS INDIVIDUAL NPI
ME0551340001Medicare NSC
ME1073773487Medicare PIN
KRRE7120Medicare ID - Type Unspecified
ME1760441042Medicare PIN
ME0006700Medicare PIN