Provider Demographics
NPI:1023026333
Name:W. STEVE KROEGER O.D., P.A.
Entity Type:Organization
Organization Name:W. STEVE KROEGER O.D., P.A.
Other - Org Name:KROEGER EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-997-7528
Mailing Address - Street 1:508 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4437
Mailing Address - Country:US
Mailing Address - Phone:830-997-7528
Mailing Address - Fax:830-997-4363
Practice Address - Street 1:508 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4437
Practice Address - Country:US
Practice Address - Phone:830-997-7528
Practice Address - Fax:830-997-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2343TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0192502-01Medicaid
TX00E18MMedicare ID - Type Unspecified
TX0456520001Medicare NSC
TXT14272Medicare UPIN
TX0192502-01Medicaid