Provider Demographics
NPI:1093754418
Name:KROSSCHELL, HENDRIK III (OD)
Entity Type:Individual
Prefix:DR
First Name:HENDRIK
Middle Name:
Last Name:KROSSCHELL
Suffix:III
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 1:54 MIDDLE HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1515
Mailing Address - Country:US
Mailing Address - Phone:401-246-2525
Mailing Address - Fax:
Practice Address - Street 1:734 NEWPORT AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5935
Practice Address - Country:US
Practice Address - Phone:508-761-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0351288Medicaid
MA0351288Medicaid
MAT-59364Medicare UPIN