Provider Demographics
NPI:1730209685
Name:LIND, KRIS EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:EDWARD
Last Name:LIND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38 SEA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2502
Mailing Address - Country:US
Mailing Address - Phone:386-446-4290
Mailing Address - Fax:
Practice Address - Street 1:110 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8241
Practice Address - Country:US
Practice Address - Phone:386-446-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT-93904Medicare UPIN