Healthcare Provider Details

I. General information

NPI: 1568494136
Provider Name (Legal Business Name): MARK A KROLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 ANDREA ST
BOWLING GREEN KY
42104-3335
US

IV. Provider business mailing address

3252 ASPEN GROVE DR STE 1
FRANKLIN TN
37067-4894
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-4909
  • Fax: 270-843-9678
Mailing address:
  • Phone: 615-786-9044
  • Fax: 615-771-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number48769
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41304
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: