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General NPI Number Information
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NPI Number | 1326280603
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Entity Type | Individual
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Provider Name | KRISTY N BOOKER LDO
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Gender | Female
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 339 N LEXINGTON SPRINGMILL RD
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City | MANSFIELD
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State | OH
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Zip | 44906-1218
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Country | US
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Telephone | 419-525-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 339 N LEX-SPRINGMILL RD
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City | MANSFIELD
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State | OH
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Zip | 44903
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Country | US
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Telephone | 419-525-2060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | S6504
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License Number State | OH
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