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NPI Code Detail

MEDICARE: DR. DAVID PAUL KRUGER OD

MEDICARE: DR. DAVID PAUL KRUGER OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist046007718IL

General Provider Information

NPI Number : 1063524775
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID PAUL KRUGER OD
Provider Business Mailing Address
First Line : 325 E CONGRESS AVE
Second Line :
City : RANTOUL
State : IL
Zip : 61866-2402
Country : US
Telephone Number : 217-892-1845
Fax Number :
Provider Business Practice Location Address
First Line : 845 BROADMEADOW RD
Second Line :
City : RANTOUL
State : IL
Zip : 61866-2119
Country : US
Telephone Number : 217-892-5095
Fax Number : 217-892-5097
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 10/08/2008

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