Provider Demographics
NPI:1043260516
Name:KRIEGER, NEAL STANLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:STANLEY
Last Name:KRIEGER
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 1:404 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701
Mailing Address - Country:US
Mailing Address - Phone:580-920-0400
Mailing Address - Fax:580-920-9117
Practice Address - Street 1:404 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701
Practice Address - Country:US
Practice Address - Phone:580-920-0400
Practice Address - Fax:580-920-9117
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0680850001Medicare NSC
OKOKA100147Medicare PIN