Provider Demographics
NPI:1780803403
Name:KRYMIS, AUGUST ANDRE JR (OD)
Entity type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:ANDRE
Last Name:KRYMIS
Suffix:JR
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 1:4425 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2648
Mailing Address - Country:US
Mailing Address - Phone:369-345-4425
Mailing Address - Fax:269-345-4435
Practice Address - Street 1:4425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2648
Practice Address - Country:US
Practice Address - Phone:369-345-4425
Practice Address - Fax:269-345-4435
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5052968Medicaid
MI0M98520Medicare ID - Type Unspecified
MIU08629Medicare UPIN