Active NPI
Kelly M. Kruk, D.O., D.A.
- Ophthalmology Physician
- St Simons Island, GA
National Provider Identifier
1285682435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 271534
- Practice address
- 10 Fern LN
Saint Simons Island, GA 31522-2700 - Phone
- (304) 716-1912
- NPI assigned
- May 4, 2006
- Last updated
- Aug 21, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | DA00245 | RI | |
| Ophthalmology Physician | 207W00000X | 271534 | NY | Primary |
Addresses
Primary practice location
10 Fern LN
Saint Simons Island, GA 31522-2700
Mailing address
10 Fern LN
Saint Simons Island, GA 31522-2700
Phone (304) 716-1912
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DA00245 | RI | MD | Acupuncturist |
| 271534 | NY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597968000000",
"number": "1285682435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 FERN LN",
"city": "SAINT SIMONS ISLAND",
"state": "GA",
"postal_code": "315222700",
"telephone_number": "304-716-1912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 FERN LN",
"city": "SAINT SIMONS ISLAND",
"state": "GA",
"postal_code": "315222700",
"telephone_number": "304-716-1912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUK",
"first_name": "KELLY",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "D.O., D.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2020-08-21",
"certification_date": "2020-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "RI",
"license": "DA00245",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NY",
"license": "271534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Simons Island, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.