Provider Demographics
NPI:1942301551
Name:BURNS, KRISTIN GULLEKSON (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:GULLEKSON
Last Name:BURNS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7101 E 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9101
Mailing Address - Country:US
Mailing Address - Phone:303-960-7989
Mailing Address - Fax:720-872-3484
Practice Address - Street 1:7101 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9101
Practice Address - Country:US
Practice Address - Phone:303-960-7989
Practice Address - Fax:720-872-3484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU49220Medicare UPIN