Provider Demographics
NPI:1588655492
Name:MCDOUGALL, KRISTIN SUE (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:SUE
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11376 SUMNER WAY
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-2651
Mailing Address - Country:US
Mailing Address - Phone:614-580-4071
Mailing Address - Fax:
Practice Address - Street 1:7 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2166
Practice Address - Country:US
Practice Address - Phone:740-335-1181
Practice Address - Fax:740-335-1182
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist