Provider Demographics
NPI:1154316461
Name:KREUTER, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KREUTER
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 1:1222 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1625
Mailing Address - Country:US
Mailing Address - Phone:740-687-1502
Mailing Address - Fax:740-687-4723
Practice Address - Street 1:1222 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1625
Practice Address - Country:US
Practice Address - Phone:740-687-1502
Practice Address - Fax:740-687-4723
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0798909Medicaid
OH0465550001Medicare PIN
OHU12929Medicare UPIN
OH0798909Medicaid