Provider Demographics
NPI:1730293119
Name:HEIDAR, KRISTA ANNETTE (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANNETTE
Last Name:HEIDAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANNETTE
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 MULBERRY ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4739
Practice Address - Country:US
Practice Address - Phone:505-243-9739
Practice Address - Fax:505-842-0650
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046976207W00000X
NMMD2022-1530207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8861563Medicare PIN
I37965Medicare UPIN