Healthcare Provider Details

I. General information

NPI: 1942387428
Provider Name (Legal Business Name): KRANSTON G BOODRAM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 MAGUIRE RD
WINDERMERE FL
34786-6057
US

IV. Provider business mailing address

1911 N MILLS AVE
ORLANDO FL
32803-1407
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-8300
  • Fax: 407-295-8742
Mailing address:
  • Phone: 407-893-8200
  • Fax: 407-893-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: