Provider Demographics
NPI:1912310673
Name:STUPIANSKY, KRISTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:STUPIANSKY
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 1:800 NEW JERSEY AVE SE APT 932
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3999
Mailing Address - Country:US
Mailing Address - Phone:303-817-2286
Mailing Address - Fax:
Practice Address - Street 1:1919 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3404
Practice Address - Country:US
Practice Address - Phone:202-467-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2609152W00000X, 152W00000X
VA0618002604152W00000X
DCOP1000368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist