MEDICARE: KREGG KOONS O.D., INC.

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	18002701	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215274626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREGG KOONS O.D., INC.

Provider Business Mailing Address
First Line	:	5535 S SCATTERFIELD RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46013-3140
Country	:	US
Telephone Number	:	765-642-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 S SCATTERFIELD RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46013-3140
Country	:	US
Telephone Number	:	765-642-7822
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KREGG C KOONS
Credential	:	O.D.
Telephone Number	:	765-289-4727

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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