Provider Demographics
NPI:1609531953
Name:KERN, KRISTIN MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:KERN
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 1:230 W TIOGA ST STE 4
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-6668
Mailing Address - Country:US
Mailing Address - Phone:570-665-5076
Mailing Address - Fax:
Practice Address - Street 1:230 W TIOGA ST STE 4
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-6668
Practice Address - Country:US
Practice Address - Phone:570-665-5076
Practice Address - Fax:570-836-4052
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist