Provider Demographics
NPI:1316140890
Name:DAVID M KRUSE OD PA
Entity type:Organization
Organization Name:DAVID M KRUSE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD PA
Authorized Official - Phone:507-847-5951
Mailing Address - Street 1:709 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1647
Mailing Address - Country:US
Mailing Address - Phone:507-847-5951
Mailing Address - Fax:507-847-5957
Practice Address - Street 1:709 2ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1647
Practice Address - Country:US
Practice Address - Phone:507-847-5951
Practice Address - Fax:597-847-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN1915152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN015968001OtherMEDICARE DME
MN826523200Medicaid
MNDQ7129OtherMEDICARE RAILROAD
MN48476KROtherBLUE CROSS BLUE SHIELD
MN015968001OtherMEDICARE DME
MNT65746Medicare UPIN