Provider Demographics
NPI:1891760195
Name:HERLEVICH, OD & KROL, OD P.A.
Entity Type:Organization
Organization Name:HERLEVICH, OD & KROL, OD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERLEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-373-0000
Mailing Address - Street 1:4650 NW 39TH PLACE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8157
Mailing Address - Country:US
Mailing Address - Phone:352-373-0000
Mailing Address - Fax:352-376-8908
Practice Address - Street 1:4650 NW 39TH PLACE
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606
Practice Address - Country:US
Practice Address - Phone:352-373-0000
Practice Address - Fax:352-373-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1206980001Medicare ID - Type UnspecifiedPALMETTO
FLK0113Medicare PIN