Provider Demographics
NPI:1740858737
Name:TOMLINSON COONTZ, KRISTA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:ANN
Last Name:TOMLINSON COONTZ
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:TOMLINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:16200 SW PACIFIC HWY STE S
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4055
Mailing Address - Country:US
Mailing Address - Phone:503-372-1220
Mailing Address - Fax:971-762-3635
Practice Address - Street 1:16200 SW PACIFIC HWY STE S
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4055
Practice Address - Country:US
Practice Address - Phone:503-372-1220
Practice Address - Fax:971-762-3635
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist