Healthcare Provider Details

I. General information

NPI: 1629486162
Provider Name (Legal Business Name): KRISTEN MARIE PIERY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 AIRPORT RD
ROANOKE VA
24019-3813
US

IV. Provider business mailing address

UNIVERSITY OF KENTUCKY 740 S. LIMESTONE
LEXINGTON KY
40536-0284
US

V. Phone/Fax

Practice location:
  • Phone: 540-855-5100
  • Fax:
Mailing address:
  • Phone: 205-903-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1961DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: