Provider Demographics
NPI:1295288306
Name:CHEE, KRYSTAL REBECCA (OD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:REBECCA
Last Name:CHEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 E CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7543
Mailing Address - Country:US
Mailing Address - Phone:602-421-4359
Mailing Address - Fax:
Practice Address - Street 1:6131 E SOUTHERN AVE
Practice Address - Street 2:SUITE NUMBER 700
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3732
Practice Address - Country:US
Practice Address - Phone:480-830-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist