Provider Demographics
NPI:1427408798
Name:KRAMLICH, KRISTEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:KRAMLICH
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 1:200 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5704
Mailing Address - Country:US
Mailing Address - Phone:605-336-2020
Mailing Address - Fax:
Practice Address - Street 1:200 W 37TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5704
Practice Address - Country:US
Practice Address - Phone:605-336-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3487152W00000X
SD735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3487OtherSTATE LICENSE NUMBER
SD735OtherSTATE LICENSE