Provider Demographics
NPI:1104811025
Name:KENDALL L. KRUG, OD PA
Entity type:Organization
Organization Name:KENDALL L. KRUG, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-625-3937
Mailing Address - Street 1:2203 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2341
Mailing Address - Country:US
Mailing Address - Phone:785-625-3937
Mailing Address - Fax:785-625-7490
Practice Address - Street 1:2203 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2341
Practice Address - Country:US
Practice Address - Phone:785-625-3937
Practice Address - Fax:785-625-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650558OtherBLUECROSSBLUESHIELD
DC3867OtherRAILROAD MEDICARE
KS650558OtherBLUECROSSBLUESHIELD
KS650558Medicare ID - Type Unspecified