Provider Demographics
NPI:1902864523
Name:KRENZ, JAMES (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KRENZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:102 W ROCK FALLS ROAD
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-0874
Mailing Address - Country:US
Mailing Address - Phone:815-626-7700
Mailing Address - Fax:815-626-0278
Practice Address - Street 1:102 W ROCK FALLS RD
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-0874
Practice Address - Country:US
Practice Address - Phone:815-626-7700
Practice Address - Fax:815-626-0268
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0416030001OtherDMERC
IL9815400OtherBLUECROSS BLUESHIELD
ILK49806Medicare PIN