Provider Demographics
NPI:1760612956
Name:LEWIS, KRISTEN OBLAD (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:OBLAD
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:OBLAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 KING AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2252
Mailing Address - Country:US
Mailing Address - Phone:614-309-6902
Mailing Address - Fax:
Practice Address - Street 1:210 SHARON RD
Practice Address - Street 2:SUITE B
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1498
Practice Address - Country:US
Practice Address - Phone:740-477-7200
Practice Address - Fax:740-477-8349
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist