Provider Demographics
NPI:1477827236
Name:KROLL, CHRISTINE (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KROLL
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 1:3900 PARK NICOLLET BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2503
Mailing Address - Country:US
Mailing Address - Phone:952-993-3150
Mailing Address - Fax:
Practice Address - Street 1:3900 PARK NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2503
Practice Address - Country:US
Practice Address - Phone:952-993-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist