Provider Demographics
NPI:1902908627
Name:KRUEGER, PAUL LEROY (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEROY
Last Name:KRUEGER
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 1:3003 N HIGHWAY 61
Mailing Address - Street 2:PO BOX 1127
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-0019
Mailing Address - Country:US
Mailing Address - Phone:563-262-8161
Mailing Address - Fax:563-262-8987
Practice Address - Street 1:3003 N HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5811
Practice Address - Country:US
Practice Address - Phone:563-262-8161
Practice Address - Fax:563-262-8987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33143OtherWELLMARK BCBS #
IA1213751Medicaid
IA1213751Medicaid