Provider Demographics
NPI:1073996633
Name:ANDREWS, KRISTIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:LYNN
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KRISTIE
Other - Middle Name:LYNN
Other - Last Name:THIEME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:300 AUDUBON RD
Mailing Address - Street 2:
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1288
Mailing Address - Country:US
Mailing Address - Phone:920-565-3991
Mailing Address - Fax:
Practice Address - Street 1:300 AUDUBON RD
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1288
Practice Address - Country:US
Practice Address - Phone:920-565-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3384-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619065224OtherORGANIZATION (EMPLOYER) NPI