Provider Demographics
NPI:1558631960
Name:HENDRIK KROSSCHELL OD LLC
Entity Type:Organization
Organization Name:HENDRIK KROSSCHELL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENDRIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KROSSCHELL
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:508-761-6100
Mailing Address - Street 1:734 NEWPORT AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5935
Mailing Address - Country:US
Mailing Address - Phone:508-761-6100
Mailing Address - Fax:508-761-5500
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:508-761-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2923152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2202005OtherUNITED HEALTHCARE
2434507OtherAETNA/US HEALTHCARE
7901678OtherAETNA
2202005OtherAARP / MEDICARE COMPLETE
152151OtherHARVARD PILGRIM HEALTH CARE
32222OtherBMC HEALTHNET PLAN
401061OtherBLUE CHP OF RHODE ISLAND
0006046OtherNEIGHBORHOOD HEALTH PLAN
220358OtherRHODE ISLAND BCBS
MA0351288Medicaid
W15565OtherBLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS
2434507OtherAETNA/US HEALTHCARE
MAT59364Medicare UPIN