Provider Demographics
NPI:1720467277
Name:MONCRIEF, KRISTIN (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MONCRIEF
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1806
Mailing Address - Country:US
Mailing Address - Phone:419-754-0278
Mailing Address - Fax:419-754-0278
Practice Address - Street 1:4240 ASBURY DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1806
Practice Address - Country:US
Practice Address - Phone:419-754-0278
Practice Address - Fax:419-754-0278
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.11847156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician