Provider Demographics
NPI:1477624112
Name:KRUGER, RONNI SEROTA (OD)
Entity Type:Individual
Prefix:DR
First Name:RONNI
Middle Name:SEROTA
Last Name:KRUGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 AVENUE H STE 67
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2025
Mailing Address - Country:US
Mailing Address - Phone:281-342-7747
Mailing Address - Fax:281-342-4720
Practice Address - Street 1:5101 AVENUE H
Practice Address - Street 2:SUITE 67
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2025
Practice Address - Country:US
Practice Address - Phone:281-342-7747
Practice Address - Fax:281-342-4720
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4340T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP082122E3Medicaid
TXU21030Medicare UPIN
TXP082122E3Medicaid