Provider Demographics
NPI:1265115877
Name:WOLFE, KRISTIN (OD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CASEY DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9450
Mailing Address - Country:US
Mailing Address - Phone:309-678-7692
Mailing Address - Fax:
Practice Address - Street 1:1000 GANDY DANCER
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7400
Practice Address - Country:US
Practice Address - Phone:912-756-3628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist