Provider Demographics
NPI:1194795328
Name:DEHOFF, CRISTY STOCKS (OD)
Entity type:Individual
Prefix:DR
First Name:CRISTY
Middle Name:STOCKS
Last Name:DEHOFF
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 1:9440 IRONBRIDGE ROAD
Mailing Address - Street 2:PO BOX 1118
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832
Mailing Address - Country:US
Mailing Address - Phone:804-748-4877
Mailing Address - Fax:804-796-9168
Practice Address - Street 1:9440 IRONBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832
Practice Address - Country:US
Practice Address - Phone:804-748-4877
Practice Address - Fax:804-796-9168
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000413152W00000X, 152WC0802X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA222912OtherANTHEM BCBS
VA2843537OtherAETNA HMO
VA20464OtherCIGNA
VA7471353OtherAETNA PPO
VA2200095OtherUNITED HEALTHCARE
VA009232770Medicaid
VA2200095OtherUNITED HEALTHCARE