Provider Demographics
NPI:1639111388
Name:KRAHWINKEL, JODI (OD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:KRAHWINKEL
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 1:4522 DOE RUN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1855
Mailing Address - Country:US
Mailing Address - Phone:270-686-8867
Mailing Address - Fax:
Practice Address - Street 1:5031 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7410
Practice Address - Country:US
Practice Address - Phone:270-685-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1404DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77014041Medicaid
U67005Medicare UPIN
KY77014041Medicaid