Provider Demographics
NPI:1336635242
Name:ATWOOD, KRISTIN MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:ATWOOD
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 1:2200 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6346
Mailing Address - Country:US
Mailing Address - Phone:701-775-3135
Mailing Address - Fax:701-952-5005
Practice Address - Street 1:204 SO ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728-4306
Practice Address - Country:US
Practice Address - Phone:218-843-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND754152W00000X
MN3710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist