David M Kruse, OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

MN1915 Issued in MN

Practice address

709 2ND St
Jackson, MN 56143-1647

Phone

(507) 847-5951

Fax

(507) 847-5957

NPI assigned

Aug 26, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313625600000",
    "number": "1982697686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 2ND ST",
            "address_2": "PO BOX 89",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431647",
            "telephone_number": "507-847-5951",
            "fax_number": "507-847-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 2ND ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431647",
            "telephone_number": "507-847-5951",
            "fax_number": "507-847-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "DAVID",
        "middle_name": "M",
        "credential": "OD PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2011-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN1915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410040208",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "419000451",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "826523200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brianna Nicole Joel, LICSW
• Martha Arlene Johnson, PAC
• Journeys of Healing, Inc
• Johanna Kallemeyn, FNP-C
• Ronald F Kline, DO
• Clayton Roy Lewis, D.C.
• Emma Kay Lilleberg, CNP
• Marilyn A. Matejka, L.A.D.C.
• Kaley Joy McNab, FNP-C
• Nicholas Alan Miller

• All providers in Jackson, MN
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.