Provider Demographics
NPI:1306525654
Name:GAZZAWAY, KRISTA RENEE (LDO)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RENEE
Last Name:GAZZAWAY
Suffix:
Gender:F
Credentials:LDO
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Mailing Address - Street 1:4265 DESERT SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-9198
Mailing Address - Country:US
Mailing Address - Phone:435-757-0547
Mailing Address - Fax:775-348-8793
Practice Address - Street 1:2425 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1218
Practice Address - Country:US
Practice Address - Phone:775-359-8220
Practice Address - Fax:775-348-8793
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician