MEDICARE: DR. DAVID GERALD KRYGIELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003205	MI

General Provider Information

NPI Number	:	1114097821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GERALD KRYGIELL

Provider Business Mailing Address
First Line	:	1612 MICHAEL CT
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-1870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7549 TEN MILE RD
Second Line	:
City	:	CENTERLINE
State	:	MI
Zip	:	48015
Country	:	US
Telephone Number	:	586-757-5765
Fax Number	:	586-757-6638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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