Provider Demographics
NPI:1881906600
Name:SMITH, KRISTEN A (OD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:SCHUMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2493 SAINT LOUIS GALLERIA
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1113
Mailing Address - Country:US
Mailing Address - Phone:314-862-1525
Mailing Address - Fax:
Practice Address - Street 1:2493 SAINT LOUIS GALLERIA
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1113
Practice Address - Country:US
Practice Address - Phone:314-862-1525
Practice Address - Fax:314-863-6218
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist