Provider Demographics
NPI:1699342162
Name:HEATH, KRISTY MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MARIE
Last Name:HEATH
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 1:9770 DORCHESTER RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7541
Mailing Address - Country:US
Mailing Address - Phone:843-767-2328
Mailing Address - Fax:
Practice Address - Street 1:9770 DORCHESTER RD UNIT 101
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7541
Practice Address - Country:US
Practice Address - Phone:843-767-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2266152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist