Provider Demographics
NPI:1962529495
Name:WREGGIT, KRYSTINA (OD)
Entity type:Individual
Prefix:DR
First Name:KRYSTINA
Middle Name:
Last Name:WREGGIT
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 1:585 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1957
Mailing Address - Country:US
Mailing Address - Phone:901-216-7568
Mailing Address - Fax:
Practice Address - Street 1:6729 COLONNADE AVE
Practice Address - Street 2:STE. 109
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6162
Practice Address - Country:US
Practice Address - Phone:321-639-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2675152W00000X
FLOPC4396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist