Provider Demographics
NPI:1891961769
Name:KRISTI LYN RHODES
Entity Type:Organization
Organization Name:KRISTI LYN RHODES
Other - Org Name:FAMILY OPTOMETRY OF SISTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-549-2105
Mailing Address - Street 1:PO BOX 1986
Mailing Address - Street 2:304 W ADAMS
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1986
Mailing Address - Country:US
Mailing Address - Phone:541-549-2105
Mailing Address - Fax:541-549-2106
Practice Address - Street 1:304 W ADAMS
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1986
Practice Address - Country:US
Practice Address - Phone:541-549-2105
Practice Address - Fax:541-549-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2974ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV00411Medicare UPIN
OR5234650001Medicare NSC
ORR119775Medicare PIN