Provider Demographics
NPI:1295714145
Name:MAUS, KRISTIN KAY (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:KAY
Last Name:MAUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:KAY
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:619 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-2831
Mailing Address - Country:US
Mailing Address - Phone:319-372-5181
Mailing Address - Fax:319-372-0865
Practice Address - Street 1:619 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-2831
Practice Address - Country:US
Practice Address - Phone:319-372-5181
Practice Address - Fax:319-372-0865
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0474155Medicaid
IAI15931Medicare ID - Type Unspecified
IAV06317Medicare UPIN