Provider Demographics
NPI:1447330758
Name:CRIST, TROY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:WAYNE
Last Name:CRIST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9181
Mailing Address - Country:US
Mailing Address - Phone:270-825-3937
Mailing Address - Fax:270-326-2020
Practice Address - Street 1:44 MCCOY AVE
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2867
Practice Address - Country:US
Practice Address - Phone:270-825-3937
Practice Address - Fax:270-326-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1237DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012375Medicaid
KY000000340384OtherBC/BS PIN
KY1464026OtherUMWA PIN
KY201228094OtherTAX ID #
KY77902104Medicaid
KY3554179OtherAETNA PIN
KY9346900OtherPRINCIPAL FINANCIAL GROUP
KY201228094OtherTAX ID #
KY9346900OtherPRINCIPAL FINANCIAL GROUP
KY77902104Medicaid
KY77012375Medicaid
KYP00150177Medicare PIN
KY5929530001Medicare NSC