Provider Demographics
NPI:1902813314
Name:CHRISTIAN, KRISTIN E (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:E
Last Name:CHRISTIAN
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 1:300 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4569
Mailing Address - Country:US
Mailing Address - Phone:870-862-2340
Mailing Address - Fax:870-862-2548
Practice Address - Street 1:300 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4569
Practice Address - Country:US
Practice Address - Phone:870-862-2340
Practice Address - Fax:870-862-2548
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162985722Medicaid
AR162985722Medicaid
ARY10520Medicare UPIN