Provider Demographics
NPI:1720095292
Name:HARPER, KREG (OD)
Entity Type:Individual
Prefix:DR
First Name:KREG
Middle Name:
Last Name:HARPER
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 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:641-754-6245
Practice Address - Street 1:100 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-4201
Practice Address - Country:US
Practice Address - Phone:641-472-6151
Practice Address - Fax:641-472-3630
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00406801OtherRAILROAD MEDICARE
NE2176507OtherUNITED HEALTHCARE
IA0417634Medicaid
NE37107OtherBLUE CROSS & BLUE SHIELD
NE2176507OtherUNITED HEALTHCARE
IAI19374Medicare PIN