Provider Demographics
NPI:1609858620
Name:STEPHENSON, KRISTI LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:LYNN
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:GOTTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:715 N. KANSAS
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HASTINGS.
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4452
Mailing Address - Country:US
Mailing Address - Phone:402-462-9009
Mailing Address - Fax:402-462-8090
Practice Address - Street 1:715 N. KANSAS
Practice Address - Street 2:SUITE 300
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4452
Practice Address - Country:US
Practice Address - Phone:402-462-9009
Practice Address - Fax:402-462-8090
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE282021Medicare PIN
U52554Medicare UPIN