Provider Demographics
NPI:1699706515
Name:ROGERS, KRISTEL ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTEL
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1719 TOWER DR W STE 100
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7512
Mailing Address - Country:US
Mailing Address - Phone:651-257-3000
Mailing Address - Fax:
Practice Address - Street 1:6936 PINE ARBOR DR S STE 110
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4672
Practice Address - Country:US
Practice Address - Phone:651-769-1020
Practice Address - Fax:615-769-1021
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3048152W00000X
MN3057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1699706515Medicaid
WI38629900Medicaid
MN1699706515Medicaid