Provider Demographics
NPI:1679686042
Name:RUNKE, KRISTEN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RUNKE
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 1:908 WINSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066
Mailing Address - Country:US
Mailing Address - Phone:703-757-6664
Mailing Address - Fax:703-757-6667
Practice Address - Street 1:9909 GEORGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066
Practice Address - Country:US
Practice Address - Phone:703-759-0061
Practice Address - Fax:703-759-0063
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0118000120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA103213D45Medicare PIN
U34767Medicare UPIN