Provider Demographics
NPI:1700876067
Name:RHINEHART, KIRSTIN P (OD)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:P
Last Name:RHINEHART
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 1:517 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2211
Mailing Address - Country:US
Mailing Address - Phone:574-255-3188
Mailing Address - Fax:574-255-4182
Practice Address - Street 1:517 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2211
Practice Address - Country:US
Practice Address - Phone:574-255-3188
Practice Address - Fax:574-255-4182
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003234A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000292708OtherBLUE CROSS BLUE SHIELD
IN1700876067OtherNPI
IN200442800Medicaid
IN4475710001Medicare NSC
IN1700876067OtherNPI
IN239740BMedicare PIN