Provider Demographics
NPI:1780679605
Name:KRUG, KENDALL L (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:L
Last Name:KRUG
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 1:2203 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2341
Mailing Address - Country:US
Mailing Address - Phone:785-625-3937
Mailing Address - Fax:785-625-7490
Practice Address - Street 1:2203 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2341
Practice Address - Country:US
Practice Address - Phone:785-625-3937
Practice Address - Fax:785-625-7490
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1223-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1158030001OtherDMERC
410036068OtherRAILROAD MEDICARE
KS100220230DMedicaid
KS100220230DMedicaid
KST44064Medicare UPIN
KS650932Medicare ID - Type Unspecified