Provider Demographics
NPI:1053368969
Name:KRIEGE, JAMES R (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KRIEGE
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 1:5300 52ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2310
Mailing Address - Country:US
Mailing Address - Phone:262-658-8119
Mailing Address - Fax:262-658-8261
Practice Address - Street 1:5300 52ND ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2310
Practice Address - Country:US
Practice Address - Phone:262-658-8119
Practice Address - Fax:262-658-8261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38413700Medicaid
WIU29782Medicare UPIN