Provider Demographics
NPI:1790990745
Name:ROBERT J. KRAUEL O.D.,LLC
Entity Type:Organization
Organization Name:ROBERT J. KRAUEL O.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KRAUEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-573-2020
Mailing Address - Street 1:229 N EGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1741
Mailing Address - Country:US
Mailing Address - Phone:541-573-2020
Mailing Address - Fax:541-573-2797
Practice Address - Street 1:229 N EGAN AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1741
Practice Address - Country:US
Practice Address - Phone:541-573-2020
Practice Address - Fax:541-573-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1438ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274323Medicaid
OR274323Medicaid
140645Medicare PIN