MEDICARE: KRASKOWSKY OPTOMETRY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11477	CA

General Provider Information

NPI Number	:	1174050934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRASKOWSKY OPTOMETRY, INC.

Provider Business Mailing Address
First Line	:	3201 DANVILLE BLVD
Second Line	:	SUITE 165
City	:	ALAMO
State	:	CA
Zip	:	94507-1938
Country	:	US
Telephone Number	:	925-820-6622
Fax Number	:	925-820-5226

Provider Business Practice Location Address
First Line	:	3201 DANVILLE BLVD
Second Line	:	SUITE 165
City	:	ALAMO
State	:	CA
Zip	:	94507-1938
Country	:	US
Telephone Number	:	925-820-6622
Fax Number	:	925-820-5226

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY KRASKOWSKY
Credential	:	O.D.
Telephone Number	:	925-820-6622

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	08/13/2022

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