Provider Demographics
NPI:1558420547
Name:KESSLER-WILLIAMS, KRISTI ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ROSE
Last Name:KESSLER-WILLIAMS
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 1:201 S MULDROW ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-1980
Mailing Address - Country:US
Mailing Address - Phone:573-581-8811
Mailing Address - Fax:573-582-7007
Practice Address - Street 1:201 S MULDROW ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-1980
Practice Address - Country:US
Practice Address - Phone:573-581-8811
Practice Address - Fax:573-582-7007
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO91003Medicare ID - Type UnspecifiedGROUP NUMBER FOR MEDICARE
MOU71110Medicare UPIN