MEDICARE: KIRSTEN P. DERR 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	418	NM
2	152W00000X	Optometrist	OPT.0003642	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00151450	OTHER	NM	RRB MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	NM02P497	OTHER	NM	BC BS OF NM

General Provider Information

NPI Number	:	1558356980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN P. DERR O.D.

Provider Business Mailing Address
First Line	:	190 TALISMAN DR UNIT B4
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9171
Country	:	US
Telephone Number	:	970-731-4347
Fax Number	:	970-731-4347

Provider Business Practice Location Address
First Line	:	190 TALISMAN DR UNIT B4
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9171
Country	:	US
Telephone Number	:	970-731-4347
Fax Number	:	970-731-4772

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	12/15/2022

Similar Medicare Providers

1164386165 — DOROTHY HORN RDH
Practice Location Address:

190 TALISMAN DR UNIT D4
PAGOSA SPRINGS, CO
81147-9171

Practice Phone: 970-585-4424
Practice Fax:

1518821511 — SUMMIT DENTAL SPA, LLC
Practice Location Address:

190 TALISMAN DR UNIT D4
PAGOSA SPRINGS, CO
81147-9171

Practice Phone: 970-585-4424
Practice Fax:

1194713057 — CCC OPTICAL PC
Practice Location Address:

190 TALISMAN DR , SUITE B4
PAGOSA SPRINGS, CO
81147-9171

Practice Phone: 970-731-4347
Practice Fax:

1396770962 — JONATHAN ELLIOT ZISSMAN O.D.
Practice Location Address:

190 TALISMAN DR UNIT B4
PAGOSA SPRINGS, CO
81147-9171

Practice Phone: 970-731-4347
Practice Fax:

1649205113 — ARCHULETA EYECARE ASSOCIATES, LLC
Practice Location Address:

190 TALISMAN DR UNIT B4
PAGOSA SPRINGS, CO
81147-9171

Practice Phone: 970-731-4347
Practice Fax:

1053441634 — PEAK PHYSICAL THERAPY INC
Practice Location Address:

190 TALISMAN DR , UNIT D4
PAGOSA SPRINGS, CO
81147-9171

Practice Phone: 970-731-1888
Practice Fax: 970-731-1889

Directions to “ KIRSTEN P. DERR O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.