Provider Demographics
NPI:1811043102
Name:KRALL, JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:KRALL
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 1:1415 N SANBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1015
Mailing Address - Country:US
Mailing Address - Phone:605-996-2020
Mailing Address - Fax:605-990-3937
Practice Address - Street 1:1415 N SANBORN BLVD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1015
Practice Address - Country:US
Practice Address - Phone:605-996-2020
Practice Address - Fax:605-990-3937
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD494152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9202632Medicaid
SD9202632Medicaid
SD2390Medicare ID - Type Unspecified