Healthcare Provider Details

I. General information

NPI: 1649300468
Provider Name (Legal Business Name): ESCONDIDO OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E OHIO AVE
ESCONDIDO CA
92025-3421
US

IV. Provider business mailing address

810 E OHIO AVE
ESCONDIDO CA
92025-3421
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-3937
  • Fax: 760-746-3991
Mailing address:
  • Phone: 760-746-3937
  • Fax: 760-746-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: HOWARD I. KRAUSZ
Title or Position: OWNER
Credential: MD
Phone: 760-746-3937