Provider Demographics
NPI:1386878965
Name:POE, KRISTI KAYLYNN (OD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAYLYNN
Last Name:POE
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 1:820 OCEAN BEACH HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4080
Mailing Address - Country:US
Mailing Address - Phone:360-636-2020
Mailing Address - Fax:360-425-0221
Practice Address - Street 1:820 OCEAN BEACH HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4080
Practice Address - Country:US
Practice Address - Phone:360-636-2020
Practice Address - Fax:360-425-0221
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60099365152W00000X
WAOD60099365152WC0802X, 152WL0500X, 152WX0102X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006635Medicaid
WA50D2022229OtherCLIA#
WA2006635Medicaid