Provider Demographics
NPI:1932210143
Name:SCHAMBER, KRISTEL RAE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:RAE
Last Name:SCHAMBER
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 1:7734 EXCELSIOR RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8696
Mailing Address - Country:US
Mailing Address - Phone:218-829-2929
Mailing Address - Fax:218-829-4747
Practice Address - Street 1:7734 EXCELSIOR RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8696
Practice Address - Country:US
Practice Address - Phone:218-829-2929
Practice Address - Fax:218-829-4747
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2202788OtherMEDICA
MN325K7TAOtherBCBS
MN308606200Medicaid
V03532Medicare UPIN
MN308606200Medicaid