Healthcare Provider Details

I. General information

NPI: 1841119450
Provider Name (Legal Business Name): OKALOOSA OPHTHALMOLOGY PEDIATRIC & ADULT EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRICE-GREGORY WAY
CRESTVIEW FL
32536-5305
US

IV. Provider business mailing address

100 PRICE-GREGORY WAY
CRESTVIEW FL
32536-5305
US

V. Phone/Fax

Practice location:
  • Phone: 850-683-3937
  • Fax: 850-683-0227
Mailing address:
  • Phone: 850-683-3937
  • Fax: 850-683-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY KRUGER
Title or Position: OWNER
Credential: DO
Phone: 850-683-3937