Provider Demographics
NPI:1760762769
Name:KRISTOLLARI, ANISA (OPTOMETRY DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ANISA
Middle Name:
Last Name:KRISTOLLARI
Suffix:
Gender:F
Credentials:OPTOMETRY DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 LYONS RD. PROMENADE EYE CARE
Mailing Address - Street 2:STE 101 NEXT TO LENSCRAFTERS OPTIQUE
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-975-9181
Mailing Address - Fax:954-975-9597
Practice Address - Street 1:4413 LYONS RD. PROMENADE EYE CARE
Practice Address - Street 2:STE 101 NEXT TO LENSCRAFTERS OPTIQUE
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-975-9181
Practice Address - Fax:954-975-9597
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4633152W00000X
OH6051/T2966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC 4633OtherFLORIDA OPTOMETRY LICENSE