Provider Demographics
NPI:1700851383
Name:SEMENICK, KRISTEN MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:SEMENICK
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 1:833 SOUTH GOVERNORS AV
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4158
Mailing Address - Country:US
Mailing Address - Phone:302-674-1121
Mailing Address - Fax:302-674-3891
Practice Address - Street 1:833 SOUTH GOVERNORS AV
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4158
Practice Address - Country:US
Practice Address - Phone:302-674-1121
Practice Address - Fax:302-674-3891
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE130001300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510111OPTOtherBCBS OF DELAWARE
DE1000037722Medicaid
DE2623617000OtherAMERI HEALTH
DE018071D99Medicare ID - Type Unspecified
DE510111OPTOtherBCBS OF DELAWARE