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General NPI Number Information
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NPI Number | 1811120538
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Entity Type | Individual
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Provider Name | KRISTINA DIMOVA O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 85 BEACH ST. BUILDING B UNIT 4
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City | WESTERLY
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State | RI
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Zip | 02891-2718
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Country | US
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Telephone | 401-596-2292
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Fax | 401-596-4910
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Provider Business Mailing Address
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Address Line | 85 BEACH ST. BUILDING B UNIT 4
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City | WESTERLY
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State | RI
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Zip | 02891-2718
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Country | US
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Telephone | 401-596-2292
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Fax | 401-596-4910
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | CODTG00623
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODTG00623
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License Number State | RI
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