Provider Demographics
NPI:1740578202
Name:GAUS, KRISTEN NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:GAUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE GAUS
Other - Last Name:MIKKELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:620 SIERRA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2072
Mailing Address - Country:US
Mailing Address - Phone:775-689-4519
Mailing Address - Fax:775-829-2018
Practice Address - Street 1:620 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2072
Practice Address - Country:US
Practice Address - Phone:775-689-4519
Practice Address - Fax:775-829-2018
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV703152W00000X
OR3466ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist