Individual
KRISTINA DIMOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
85 BEACH ST., BUILDING B UNIT 4, WESTERLY, RI 02891-2718
(401) 596-2292
(401) 596-4910
Mailing address
85 BEACH ST., BUILDING B UNIT 4, WESTERLY, RI 02891-2718
(401) 596-2292
(401) 596-4910
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
CODTG00623
RI
152W00000X
Optometrist
Primary
ODTG00623
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811120538
ALL OTHER PAYERS
RI
Enumeration date
08/27/2009
Last updated
07/06/2020
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