MEDICARE: CHARLES D KREBS

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	156FX1800X	Optician	0372	KY

General Provider Information

NPI Number	:	1982792271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES D KREBS

Provider Business Mailing Address
First Line	:	129 SAINT MATTHEWS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3141
Country	:	US
Telephone Number	:	502-897-1199
Fax Number	:	502-897-0180

Provider Business Practice Location Address
First Line	:	129 SAINT MATTHEWS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3141
Country	:	US
Telephone Number	:	502-897-1199
Fax Number	:	502-897-0180

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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