Provider Demographics
NPI:1861461659
Name:KREBS, CHARLES RYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RYAN
Last Name:KREBS
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:CMR 411, BOX 6202
Mailing Address - Street 2:VILSECK HEALTH CLINIC
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:01149966-283-3325
Mailing Address - Fax:
Practice Address - Street 1:CMR 411, BOX 6202
Practice Address - Street 2:VILSECK HEALTH CLINIC
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:01149966-283-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1620 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist