Provider Demographics
NPI:1891758207
Name:KRIEG, STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:KRIEG
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 1:25 CONSUMER SQ
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6508
Mailing Address - Country:US
Mailing Address - Phone:518-566-8096
Mailing Address - Fax:518-566-0085
Practice Address - Street 1:25 CONSUMER SQ
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6508
Practice Address - Country:US
Practice Address - Phone:518-566-8096
Practice Address - Fax:518-566-0085
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4915152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01120378Medicaid
NY01120378Medicaid
NY52740BMedicare ID - Type Unspecified