Provider Demographics
NPI:1386657831
Name:KRIEG, BRUCE E (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:KRIEG
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 1:3200 OLD BOYNTON RD
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6506
Mailing Address - Country:US
Mailing Address - Phone:561-737-0510
Mailing Address - Fax:
Practice Address - Street 1:3200 OLD BOYNTON RD
Practice Address - Street 2:VISION CENTER
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6506
Practice Address - Country:US
Practice Address - Phone:561-737-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0844411Medicaid
FLT83995Medicare UPIN
FL19302Medicare ID - Type Unspecified