Provider Demographics
NPI:1023321767
Name:ROY, KRIS JANIK (OD)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:JANIK
Last Name:ROY
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 1:12441 BAYLEAF CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9168
Mailing Address - Country:US
Mailing Address - Phone:919-556-1530
Mailing Address - Fax:919-556-6769
Practice Address - Street 1:2114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8817
Practice Address - Country:US
Practice Address - Phone:919-556-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist