Healthcare Provider Details

I. General information

NPI: 1518954940
Provider Name (Legal Business Name): STEVEN M. KREIGER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MAIN ST
WAKEFIELD RI
02879-3511
US

IV. Provider business mailing address

133 MAIN ST
WAKEFIELD RI
02879-3511
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-8150
  • Fax: 401-783-9710
Mailing address:
  • Phone: 401-782-8150
  • Fax: 401-783-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00464
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: