MEDICARE: DR. KRISTEN A WESLOCK OD

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	046-008752	IL
2	152W00000X	Optometrist	R-311	AL

General Provider Information

NPI Number	:	1184614943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN A WESLOCK OD

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 N CHALKVILLE RD
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1376
Country	:	US
Telephone Number	:	205-445-2020
Fax Number	:	205-655-3194

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	05/31/2022

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