Active NPI
Kendall L Krug, O.D.
- Optometrist
- Hays, KS
National Provider Identifier
1780679605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1223-3
- Practice address
- 2203 Canterbury Dr
Hays, KS 67601-2341 - Phone
- (785) 625-3937
- Fax
- (785) 625-7490
- NPI assigned
- Sep 16, 2005
- Last updated
- Jul 1, 2014
- Sex
- Male
- Sole proprietor
- No
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 | 1223-3 | KS | Primary |
Addresses
Primary practice location
2203 Canterbury Dr
Hays, KS 67601-2341
Mailing address
2203 Canterbury Dr
Hays, KS 67601-2341
Phone (785) 625-3937
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100220230D | Medicaid | KS | |
| 410036068 | Other | RAILROAD MEDICARE | |
| 1158030001 | Other | KS | DMERC |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1223-3 | KS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jubilee Eye Care, LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Hays, KS
- NPI 1104811025
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404172800000",
"number": "1780679605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2203 CANTERBURY DR",
"city": "HAYS",
"state": "KS",
"postal_code": "676012341",
"telephone_number": "785-625-3937",
"fax_number": "785-625-7490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2203 CANTERBURY DR",
"city": "HAYS",
"state": "KS",
"postal_code": "676012341",
"telephone_number": "785-625-3937",
"fax_number": "785-625-7490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUG",
"first_name": "KENDALL",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-16",
"last_updated": "2014-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KS",
"license": "1223-3",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100220230D",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410036068",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "1158030001",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hays, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.