Healthcare Provider Details

I. General information

NPI: 1700851383
Provider Name (Legal Business Name): KRISTEN MARIE SEMENICK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SOUTH GOVERNORS AV
DOVER DE
19904-4158
US

IV. Provider business mailing address

833 SOUTH GOVERNORS AV
DOVER DE
19904-4158
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-1121
  • Fax: 302-674-3891
Mailing address:
  • Phone: 302-674-1121
  • Fax: 302-674-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number130001300
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: