Provider Demographics
NPI:1316250459
Name:KREIN, MATTHEW D (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:KREIN
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 1:103 DIECKS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2444
Mailing Address - Country:US
Mailing Address - Phone:270-769-1397
Mailing Address - Fax:270-765-4899
Practice Address - Street 1:103 DIECKS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2444
Practice Address - Country:US
Practice Address - Phone:270-769-1397
Practice Address - Fax:270-765-4899
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2659152W00000X
KY1880DT152W00000X
AR2665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4T086B199OtherMEDICARE PTAN
AR4T086B199OtherMEDICARE PTAN