Provider Demographics
NPI:1558350850
Name:MOSTELLO, KRISTEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:MOSTELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2707 CARMEL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1560
Mailing Address - Country:US
Mailing Address - Phone:281-291-9669
Mailing Address - Fax:713-920-1191
Practice Address - Street 1:1100 PASADENA BLVD
Practice Address - Street 2:STE D
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4766
Practice Address - Country:US
Practice Address - Phone:713-920-2020
Practice Address - Fax:713-920-1191
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4846T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35897Medicare UPIN