Provider Demographics
NPI:1184645111
Name:SEMROW, KRISTIE RENAE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:RENAE
Last Name:SEMROW
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 1:3118 SE HONEYSUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-7213
Mailing Address - Country:US
Mailing Address - Phone:515-965-0610
Mailing Address - Fax:
Practice Address - Street 1:3800 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-3402
Practice Address - Country:US
Practice Address - Phone:515-292-4269
Practice Address - Fax:515-268-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA2357OtherEYEMED
IA0741561Medicaid
IA26206OtherBCBS
IA54062OtherDAVIS VISION
IA44382OtherSPECTERA
IA25587OtherAVESIS