Provider Demographics
NPI:1346430378
Name:CULVER, KRISTEN SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SUE
Last Name:CULVER
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:PO BOX 1137
Mailing Address - Street 2:101 E 10TH SUITE A
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-1137
Mailing Address - Country:US
Mailing Address - Phone:573-333-1860
Mailing Address - Fax:573-333-0099
Practice Address - Street 1:101 EAST 10TH STREET SUITE A
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-1137
Practice Address - Country:US
Practice Address - Phone:573-333-1860
Practice Address - Fax:573-333-0099
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317444800Medicaid
MO990001675Medicare PIN