Provider Demographics
NPI:1689663023
Name:KRON, KIM MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARTIN
Last Name:KRON
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 1:1098 ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4318
Mailing Address - Country:US
Mailing Address - Phone:360-659-6255
Mailing Address - Fax:360-653-2466
Practice Address - Street 1:1098 ALDER AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4318
Practice Address - Country:US
Practice Address - Phone:360-659-6255
Practice Address - Fax:360-653-2466
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL1342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410029615OtherRAILROAD MEDICARE
WA2008662Medicaid
WAAB38817Medicare ID - Type Unspecified
WA410029615OtherRAILROAD MEDICARE
WA0934970001Medicare NSC