Provider Demographics
NPI:1912185950
Name:DR LAWRENCE JOSEPH KRUSE OD
Entity Type:Organization
Organization Name:DR LAWRENCE JOSEPH KRUSE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-731-7132
Mailing Address - Street 1:1421 KIRKWOOD HIGHWAY
Mailing Address - Street 2:SUITE 1106 POLLY DRYMMOND OFFICE PARK
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5705
Mailing Address - Country:US
Mailing Address - Phone:302-731-7132
Mailing Address - Fax:301-731-7132
Practice Address - Street 1:1421 KIRKWOOD HIGHWAY
Practice Address - Street 2:SUITE 1106
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5705
Practice Address - Country:US
Practice Address - Phone:302-731-7132
Practice Address - Fax:301-731-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000025822Medicaid
1073535571OtherMEDICARE-NPI-SOLO
DE0000025822Medicaid
118993Medicare PIN
T26921Medicare UPIN