Provider Demographics
NPI:1255418158
Name:KROPF, PAUL L (OD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:KROPF
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 1:872 MUNSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-947-1691
Mailing Address - Fax:231-933-6313
Practice Address - Street 1:872 MUNSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3638
Practice Address - Country:US
Practice Address - Phone:231-947-1691
Practice Address - Fax:231-933-6313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI945017931Medicaid
MIT32828Medicare UPIN
MI0B86504Medicare PIN
MI945017931Medicaid