Provider Demographics
NPI:1801956073
Name:KRUGER, JOHN J (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KRUGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1010 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4281
Mailing Address - Country:US
Mailing Address - Phone:402-880-7852
Mailing Address - Fax:
Practice Address - Street 1:10000 CALIFORNIA ST
Practice Address - Street 2:STE 2292 OMAHA WESTROADS S C
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2355
Practice Address - Country:US
Practice Address - Phone:402-393-3590
Practice Address - Fax:402-393-0371
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU27685Medicare UPIN