Basic Information
| Provider Information | |||||||||
| NPI: | 1245675701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOO | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | MAYWAH | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 BREEDERS CUP DR | ||||||||
| Address2: | |||||||||
| City: | WHITSETT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273778008 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2835 S CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272155105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368082020 | ||||||||
| FaxNumber: | 3365840003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2013 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2339 | NC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.