Provider Demographics
NPI:1932228632
Name:KROLL, ERIC ALLEN (CPO)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALLEN
Last Name:KROLL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 MILL RUN CIR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1687
Mailing Address - Country:US
Mailing Address - Phone:651-797-3777
Mailing Address - Fax:
Practice Address - Street 1:2200 UNIVERSITY AVE W
Practice Address - Street 2:SUITE #114
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1839
Practice Address - Country:US
Practice Address - Phone:651-644-5808
Practice Address - Fax:651-644-5926
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier