Provider Demographics
NPI:1659477206
Name:KREIN, KYLE D (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:KREIN
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0130
Mailing Address - Country:US
Mailing Address - Phone:701-662-4085
Mailing Address - Fax:701-662-6685
Practice Address - Street 1:404 HWY 2 EAST
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-0130
Practice Address - Country:US
Practice Address - Phone:701-662-4085
Practice Address - Fax:701-662-6685
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND439152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND450433379000OtherWORKERS SAFETY AND COMP
ND800439OtherNORTH DAKOTA VISION SERVI
ND60341Medicaid
ND8834OtherNORTH DAKOTA BLUE SHIED
ND0311120001OtherCIGNA MEDICARE
ND800439OtherNORTH DAKOTA VISION SERVI
NDT66896Medicare UPIN