Provider Demographics
NPI:1982832887
Name:HUNNICUTT, CHRISTA MARY (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARY
Last Name:HUNNICUTT
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 128
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-0128
Mailing Address - Country:US
Mailing Address - Phone:402-694-6114
Mailing Address - Fax:
Practice Address - Street 1:1208 L ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2016
Practice Address - Country:US
Practice Address - Phone:402-694-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6877OtherBLUE CROSS AND BLUE SHIELD
NENA1624001Medicare PIN
NE092174001Medicare PIN
NE6877OtherBLUE CROSS AND BLUE SHIELD