Provider Demographics
NPI:1669213666
Name:MERCHANT, KRISTI MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:MARIE
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GAUL DR
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8973
Mailing Address - Country:US
Mailing Address - Phone:712-943-9400
Mailing Address - Fax:
Practice Address - Street 1:620 MARKET ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1412
Practice Address - Country:US
Practice Address - Phone:712-755-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist