Healthcare Provider Details

I. General information

NPI: 1386641439
Provider Name (Legal Business Name): KRISTEN LYNN CRESSWELL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N IL ROUTE 83
MUNDELEIN IL
60060-9159
US

IV. Provider business mailing address

1505 ERIC LN
LIBERTYVILLE IL
60048-4476
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-2020
  • Fax:
Mailing address:
  • Phone: 443-812-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1069
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: