MEDICARE: KRISTI LYN RHODES O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2974T	OR
2	152WC0802X	Corneal and Contact Management Optometrist	1846	AZ
3	152W00000X	Optometrist	1846	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86-0884211	OTHER		TAX ID

General Provider Information

NPI Number	:	1134120850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI LYN RHODES O.D.

Provider Business Mailing Address
First Line	:	PO BOX 72802
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-1031
Country	:	US
Telephone Number	:	541-390-9667
Fax Number	:	480-961-4605

Provider Business Practice Location Address
First Line	:	29605 N CAVE CREEK RD STE 102
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85331-2360
Country	:	US
Telephone Number	:	480-781-4446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/25/2022

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