Provider Demographics
NPI:1154335206
Name:STALKER, KRISTI K (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:K
Last Name:STALKER
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 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4644
Mailing Address - Country:US
Mailing Address - Phone:330-456-0047
Mailing Address - Fax:330-456-9308
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-456-0047
Practice Address - Fax:330-456-9308
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4970/T1840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300656Medicaid
OH4068121Medicare ID - Type Unspecified
OHU76136Medicare UPIN