Provider Demographics
NPI:1851436661
Name:PYRITZ, KELLY CROSS (OD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CROSS
Last Name:PYRITZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:19001 N 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5036
Mailing Address - Country:US
Mailing Address - Phone:602-702-4394
Mailing Address - Fax:623-293-4436
Practice Address - Street 1:19001 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5036
Practice Address - Country:US
Practice Address - Phone:623-293-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70790Medicare ID - Type Unspecified
AZU82290Medicare UPIN