Healthcare Provider Details

I. General information

NPI: 1174050934
Provider Name (Legal Business Name): KRASKOWSKY OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/13/2022
Certification Date: 08/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 DANVILLE BLVD SUITE 165
ALAMO CA
94507-1938
US

IV. Provider business mailing address

3201 DANVILLE BLVD SUITE 165
ALAMO CA
94507-1938
US

V. Phone/Fax

Practice location:
  • Phone: 925-820-6622
  • Fax: 925-820-5226
Mailing address:
  • Phone: 925-820-6622
  • Fax: 925-820-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11477
License Number StateCA

VIII. Authorized Official

Name: DR. GREGORY KRASKOWSKY
Title or Position: OWNER
Credential: O.D.
Phone: 925-820-6622