MEDICARE: DR. KRISTEN LYNN CRESSWELL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1069	MD
2	152W00000X	Optometrist	046010872	IL

General Provider Information

NPI Number	:	1386641439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN LYNN CRESSWELL O.D.

Provider Business Mailing Address
First Line	:	1505 ERIC LN
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-4476
Country	:	US
Telephone Number	:	443-812-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 N IL ROUTE 83
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-9159
Country	:	US
Telephone Number	:	847-362-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/21/2022

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