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General NPI Number Information
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NPI Number | 1659552073
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Entity Type | Organization
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Legal Business Name | CHARLES KREBS OPTICAL SHOPPE
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 129 SAINT MATTHEWS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-3141
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Country | US
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Telephone | 502-897-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 129 SAINT MATTHEWS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-3141
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Country | US
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Telephone | 502-897-1199
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | MARK BABCOCK
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Credential |
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Telephone | 502-897-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0372
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License Number State | KY
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