Provider Demographics
NPI:1205877891
Name:MACLUSKIE, KRISTY A (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:A
Last Name:MACLUSKIE
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 1:27 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4833
Mailing Address - Country:US
Mailing Address - Phone:856-327-3098
Mailing Address - Fax:
Practice Address - Street 1:510 CONSUMER SQ
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3328
Practice Address - Country:US
Practice Address - Phone:609-641-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00595100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist