Provider Demographics
NPI:1073535571
Name:KRUSE, LAWRENCE JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:KRUSE
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 1:1106 DRUMMOND PLAZA
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5705
Mailing Address - Country:US
Mailing Address - Phone:302-731-7132
Mailing Address - Fax:302-731-7132
Practice Address - Street 1:1106 DRUMMOND PLAZA
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5705
Practice Address - Country:US
Practice Address - Phone:302-731-7132
Practice Address - Fax:302-731-7132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081040000OtherAMERIHEALTH
DE0000025822Medicaid
0505233OtherAETNA INS CO
T26921Medicare UPIN
0081040000OtherAMERIHEALTH
118993Medicare PIN