Provider Demographics
NPI:1588808331
Name:DR DANIEL J. KROGER
Entity Type:Organization
Organization Name:DR DANIEL J. KROGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMOTRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KROGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-777-3936
Mailing Address - Street 1:7322 KINGSGATE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6566
Mailing Address - Country:US
Mailing Address - Phone:513-777-3936
Mailing Address - Fax:513-777-4746
Practice Address - Street 1:7322 KINGSGATE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6566
Practice Address - Country:US
Practice Address - Phone:513-777-3936
Practice Address - Fax:513-777-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0747190001Medicare NSC