Provider Demographics
NPI:1992735815
Name:PUSSER, KRYSTAL L (OD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:PUSSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:P
Other - Last Name:BRAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606537HOtherMEDICAID - RINCON
GA1992735815OtherMEDICARE RAILROAD
GA000606537FMedicaid
GA000606537GOtherMEDICAID- BORO
GA111065OtherNATL VISION ADMIN
GA732348OtherBCBS
GA000606537DMedicaid
GA000606537AMedicaid
GA000606537EMedicaid
GA08525OtherSPECTERA
GA52484359OtherSTATE HEALTH PLAN
GAP00013749OtherRAILROAD MEDICARE
GA511G701032OtherGA MEDICARE GROUP
GA000606537FMedicaid
GA000606537DMedicaid
GA0412940007Medicare NSC
GA0412940005Medicare NSC
GA0412940004Medicare NSC
GA52484359OtherSTATE HEALTH PLAN
GA000606537HOtherMEDICAID - RINCON
GA08525OtherSPECTERA
GA511G701032OtherGA MEDICARE GROUP
GA000606537AMedicaid
GA0412940001Medicare NSC
GAP00385261Medicare PIN