Provider Demographics
NPI:1164046629
Name:PARK, KRISTIN FRANCES (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:FRANCES
Last Name:PARK
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 1:248 MCCASLIN BLVD
Mailing Address - Street 2:APT 207
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2918
Mailing Address - Country:US
Mailing Address - Phone:925-876-0381
Mailing Address - Fax:
Practice Address - Street 1:180 KEN PRATT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8974
Practice Address - Country:US
Practice Address - Phone:303-776-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist