Provider Demographics
NPI:1851531297
Name:ADAMS, KRISTA N (OD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:N
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 DAVIS STUART RD
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-0260
Mailing Address - Country:US
Mailing Address - Phone:304-793-3937
Mailing Address - Fax:304-793-2203
Practice Address - Street 1:3942 DAVIS STUART RD
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-0260
Practice Address - Country:US
Practice Address - Phone:304-793-3937
Practice Address - Fax:304-793-2203
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1054OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1054ODOtherWVBO