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General NPI Number Information
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NPI Number | 1316140890
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Entity Type | Organization
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Legal Business Name | DAVID M KRUSE OD PA
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 709 2ND ST
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City | JACKSON
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State | MN
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Zip | 56143-1647
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Country | US
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Telephone | 507-847-5951
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Fax | 597-847-5957
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Provider Business Mailing Address
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Address Line | 709 2ND ST
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City | JACKSON
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State | MN
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Zip | 56143-1647
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Country | US
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Telephone | 507-847-5951
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Fax | 507-847-5957
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DAVID M KRUSE
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Credential | OD PA
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Telephone | 507-847-5951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | MN1915
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License Number State | MN
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