Provider Demographics
NPI:1396277885
Name:GREENE, KRISTA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:LYNN
Last Name:GREENE
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 1:6063 GREENWAY COURT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112
Mailing Address - Country:US
Mailing Address - Phone:703-851-1975
Mailing Address - Fax:
Practice Address - Street 1:3259 CATILIN AVENUE
Practice Address - Street 2:NAVAL HEALTH CLINIC, QUANTICO
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134
Practice Address - Country:US
Practice Address - Phone:703-851-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist