Provider Demographics
NPI:1437160900
Name:WOODS, KRISTEN GILLOGLY (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:GILLOGLY
Last Name:WOODS
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 1:2034 S WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2702
Mailing Address - Country:US
Mailing Address - Phone:901-292-1046
Mailing Address - Fax:
Practice Address - Street 1:2021 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3748
Practice Address - Country:US
Practice Address - Phone:417-886-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOVO6192Medicare UPIN
MO000E054Medicare ID - Type Unspecified