Provider Demographics
NPI:1518954940
Name:KREIGER, STEVEN M (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:KREIGER
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 1:133 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3511
Mailing Address - Country:US
Mailing Address - Phone:401-782-8150
Mailing Address - Fax:401-783-9710
Practice Address - Street 1:133 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3511
Practice Address - Country:US
Practice Address - Phone:401-782-8150
Practice Address - Fax:401-783-9710
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISK00695Medicaid
RI007008514Medicare PIN
RIT79219Medicare UPIN