Provider Demographics
NPI:1104808500
Name:KRIEGER, STUART (OD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3410
Mailing Address - Country:US
Mailing Address - Phone:631-499-8811
Mailing Address - Fax:631-499-8846
Practice Address - Street 1:77 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3410
Practice Address - Country:US
Practice Address - Phone:631-499-8811
Practice Address - Fax:631-499-8846
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0078408OtherGHI
NYP2121183OtherOXFORD
NYC93021OtherBLUE CROSS BLUE SHIELD
NY00388087Medicaid
NY4413816OtherAETNA
NYT49180Medicare UPIN
NY0078408OtherGHI