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General NPI Number Information
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NPI Number | 1558631960
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Entity Type | Organization
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Legal Business Name | HENDRIK KROSSCHELL OD LLC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 734 NEWPORT AVE UNIT 4
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City | ATTLEBORO
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State | MA
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Zip | 02703-5935
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Country | US
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Telephone | 508-761-6100
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Fax | 508-761-5500
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Provider Business Mailing Address
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Address Line | 734 NEWPORT AVE UNIT 4
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City | ATTLEBORO
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State | MA
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Zip | 02703-5935
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Country | US
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Telephone | 508-761-6100
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Fax | 508-761-5500
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Authorized Official
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Title or Position | OWNER
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Name | DR. HENDRIK KROSSCHELL III
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Credential | O.D.
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Telephone | 508-761-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2923
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License Number State | MA
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