Provider Demographics
NPI:1700982915
Name:GABRENYA, KRISTINA T (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:T
Last Name:GABRENYA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:T
Other - Last Name:ZETLMEISL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:463 TENNYSON RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4616
Mailing Address - Country:US
Mailing Address - Phone:630-300-8043
Mailing Address - Fax:630-837-9517
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4456
Practice Address - Country:US
Practice Address - Phone:630-837-9500
Practice Address - Fax:630-837-9517
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009200152W00000X
MOT03484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
212593Medicare ID - Type Unspecified
U77977Medicare UPIN