Provider Demographics
NPI:1679100721
Name:KRIS J. STORKERSEN M.D. INC.
Entity Type:Organization
Organization Name:KRIS J. STORKERSEN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPHTHALMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STORKERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-213-6737
Mailing Address - Street 1:400 N PEPPER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-2505
Mailing Address - Fax:909-580-1439
Practice Address - Street 1:400 N PEPPER AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-2505
Practice Address - Fax:909-580-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty