Active NPI
David Paul Kruger, OD
- Optometrist
- Rantoul, IL
National Provider Identifier
1063524775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046007718
- Practice address
- 845 Broadmeadow Rd
Rantoul, IL 61866-2119 - Phone
- (217) 892-5095
- Fax
- (217) 892-5097
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046007718 | IL | Primary |
Addresses
Primary practice location
845 Broadmeadow Rd
Rantoul, IL 61866-2119
Mailing address
325 E Congress Ave
Rantoul, IL 61866-2402
Phone (217) 892-1845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chittick Family Eye Care LTD | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1063524775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 E CONGRESS AVE",
"city": "RANTOUL",
"state": "IL",
"postal_code": "618662402",
"telephone_number": "217-892-1845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 BROADMEADOW RD",
"city": "RANTOUL",
"state": "IL",
"postal_code": "618662119",
"telephone_number": "217-892-5095",
"fax_number": "217-892-5097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUGER",
"first_name": "DAVID",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046007718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rantoul, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.