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General NPI Number Information
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NPI Number | 1346240413
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Entity Type | Individual
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Provider Name | THEODORE D KRESS OD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 920 W MAIN ST
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1651
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Country | US
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Telephone | 304-842-4444
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Fax | 304-842-4491
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Provider Business Mailing Address
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Address Line | 100 W MAIN ST STE A
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City | BUCKHANNON
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State | WV
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Zip | 26201-2292
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Country | US
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Telephone | 304-842-4444
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Fax | 304-842-4491
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 958-OD
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License Number State | WV
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