Provider Demographics
NPI:1992702864
Name:RADANEATA, CRISTIAN (OD)
Entity type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:
Last Name:RADANEATA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6422
Mailing Address - Country:US
Mailing Address - Phone:361-592-4744
Mailing Address - Fax:
Practice Address - Street 1:1016 S 14TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6422
Practice Address - Country:US
Practice Address - Phone:361-592-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5189TG152WL0500X, 152WP0200X, 152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092993701Medicaid
P01042734OtherMEDICARE RAILROAD
P01042734OtherMEDICARE RAILROAD
TX092993701Medicaid