Provider Demographics
NPI:1588914071
Name:KRONBERG, JILL (OD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KRONBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 W RIFLEMAN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9064
Mailing Address - Country:US
Mailing Address - Phone:208-377-8899
Mailing Address - Fax:
Practice Address - Street 1:7960 W RIFLEMAN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9064
Practice Address - Country:US
Practice Address - Phone:208-377-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14518152W00000X
IDODP-100270152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist