Provider Demographics
NPI:1154401438
Name:KRILL, JEFFREY P (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:KRILL
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 1:2300 N TYRONE BLVD
Mailing Address - Street 2:CO SEARS OPTICAL
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:727-341-7297
Mailing Address - Fax:727-347-0937
Practice Address - Street 1:2300 N TYRONE BLVD
Practice Address - Street 2:CO SEARS OPTICAL
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-341-7297
Practice Address - Fax:727-347-0937
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOP2068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T84224Medicare UPIN
FL19663Medicare ID - Type Unspecified