Basic Information
| Provider Information | |||||||||
| NPI: | 1114097821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRYGIELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | GERALD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 MICHAEL CT | ||||||||
| Address2: | |||||||||
| City: | CLAWSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480171870 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7549 TEN MILE RD | ||||||||
| Address2: | |||||||||
| City: | CENTERLINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867575765 | ||||||||
| FaxNumber: | 5867576638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901003205 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.