Individual
KRISTEN K DORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
120 MARTIN DR, FREDONIA, WI 53021-9455
(262) 692-9000
(262) 692-2797
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2673-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103436
HEALTH ALLIANCE
WI
01
—
38608200
WI HEALTH INS RSK SHAR PR
WI
05
—
38608200
—
WI
01
—
391101335
WI PHYS SERV WPS
WI
01
—
410041553
RAILROAD MEDICARE
WI
01
—
5300133
AETNA
WI
01
—
747042
MOHAWK
WI
01
—
822601
VIPA
WI
Enumeration date
04/27/2006
Last updated
03/12/2020
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