Provider Demographics
NPI:1013147446
Name:MIDDLESWORTH, KRISTIN S (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:S
Last Name:MIDDLESWORTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1770 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9049
Mailing Address - Country:US
Mailing Address - Phone:614-801-9193
Mailing Address - Fax:614-801-9288
Practice Address - Street 1:1770 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9049
Practice Address - Country:US
Practice Address - Phone:614-801-9193
Practice Address - Fax:614-801-9288
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist