Provider Demographics
NPI:1003046087
Name:WELLS, KRYSTAL ANN (OD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:ANN
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4353 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2709
Mailing Address - Country:US
Mailing Address - Phone:402-552-2020
Mailing Address - Fax:402-552-2367
Practice Address - Street 1:4353 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2709
Practice Address - Country:US
Practice Address - Phone:402-552-2020
Practice Address - Fax:402-552-2367
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1342152W00000X
IA002462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist