Provider Demographics
NPI:1205857943
Name:KOSIR, KRISTEN NICOLE (OD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:KOSIR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3120 25TH ST S STE X
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6110
Mailing Address - Country:US
Mailing Address - Phone:701-234-9768
Mailing Address - Fax:701-293-1510
Practice Address - Street 1:3120 25TH ST S STE X
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6110
Practice Address - Country:US
Practice Address - Phone:701-234-9768
Practice Address - Fax:701-293-1510
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist