Provider Demographics
NPI:1215599980
Name:GIANNONATTI, KYNNDYL PAIGE (OD)
Entity Type:Individual
Prefix:DR
First Name:KYNNDYL
Middle Name:PAIGE
Last Name:GIANNONATTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KYNNDYL
Other - Middle Name:PAIGE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30932 US HIGHWAY 59 SE
Mailing Address - Street 2:
Mailing Address - City:ERSKINE
Mailing Address - State:MN
Mailing Address - Zip Code:56535-9759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 DIVISION ST W
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6396
Practice Address - Country:US
Practice Address - Phone:218-759-1430
Practice Address - Fax:218-444-9086
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist