MEDICARE: DR. KRISTEN MOSTELLO O.D.

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	4846T	TX

General Provider Information

NPI Number	:	1558350850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN MOSTELLO O.D.

Provider Business Mailing Address
First Line	:	2707 CARMEL WOODS DR
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-1560
Country	:	US
Telephone Number	:	281-291-9669
Fax Number	:	713-920-1191

Provider Business Practice Location Address
First Line	:	1100 PASADENA BLVD
Second Line	:	STE D
City	:	PASADENA
State	:	TX
Zip	:	77506-4766
Country	:	US
Telephone Number	:	713-920-2020
Fax Number	:	713-920-1191

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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