Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00662200 | NJ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00662200 | NJ |
NPI | 1235515941 |
---|---|
Provider Name | Dr. Krystal Worthington |
First Address | Freehold, NJ 07728-2965 |
Second Address | Freehold, NJ 07728-2965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 04/08/2015 |