Provider Demographics
NPI:1821340159
Name:SCOTT, KIRSTEN M (OD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:6625 LYNDALE AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2491
Mailing Address - Country:US
Mailing Address - Phone:612-243-8999
Mailing Address - Fax:612-869-3473
Practice Address - Street 1:6625 LYNDALE AVE S STE 300
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2491
Practice Address - Country:US
Practice Address - Phone:612-243-8999
Practice Address - Fax:612-869-3473
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2024-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN3444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist