Provider Demographics
NPI:1922095306
Name:GYVING, KRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:GYVING
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:PO BOX 7711
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0366
Mailing Address - Country:US
Mailing Address - Phone:541-234-4866
Mailing Address - Fax:
Practice Address - Street 1:325 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9658
Practice Address - Country:US
Practice Address - Phone:541-469-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU32102Medicare UPIN
AZ78520Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBER