Provider Demographics
NPI:1356629463
Name:ZELLER, KRISTEN M (OD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:ZELLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:BRUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6751 N 72ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1746
Mailing Address - Country:US
Mailing Address - Phone:402-572-2020
Mailing Address - Fax:402-572-2150
Practice Address - Street 1:6751 N 72ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1746
Practice Address - Country:US
Practice Address - Phone:402-572-2020
Practice Address - Fax:402-572-2150
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002526152W00000X
NE1371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist