Provider Demographics
NPI:1871666370
Name:KRAUEL, ROBERT JOHN (O D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:KRAUEL
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1438ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125844Medicaid
OR125844Medicaid
OROOOOPHLCNMedicare PIN
6112820001Medicare NSC