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General NPI Number Information
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NPI Number | 1386641439
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Entity Type | Individual
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Provider Name | KRISTEN LYNN CRESSWELL O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 824 N IL ROUTE 83
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City | MUNDELEIN
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State | IL
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Zip | 60060-9159
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Country | US
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Telephone | 847-362-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 ERIC LN
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-4476
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Country | US
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Telephone | 443-812-8442
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1069
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010872
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License Number State | IL
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