Provider Demographics
NPI:1982792271
Name:KREBS, CHARLES D
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:KREBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SAINT MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3141
Mailing Address - Country:US
Mailing Address - Phone:502-897-1199
Mailing Address - Fax:502-897-0180
Practice Address - Street 1:129 SAINT MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3141
Practice Address - Country:US
Practice Address - Phone:502-897-1199
Practice Address - Fax:502-897-0180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0372156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0652670001Medicare UPIN