Provider Demographics
NPI:1295086866
Name:REMINGTON, CRYSTAL DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:DAWN
Last Name:REMINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:DAWN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4400 BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3342
Mailing Address - Country:US
Mailing Address - Phone:816-531-9100
Mailing Address - Fax:816-531-9105
Practice Address - Street 1:4400 BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-531-9100
Practice Address - Fax:816-531-9105
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017017040152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management