Healthcare Provider Details

I. General information

NPI: 1679580740
Provider Name (Legal Business Name): MRS. RENEE MARIE KRAJCAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 UNIVERSITY AVE
SYRACUSE NY
13210-1702
US

IV. Provider business mailing address

114 DEXTER AVE
LIVERPOOL NY
13088-6630
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-0373
  • Fax:
Mailing address:
  • Phone: 315-263-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number008058-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: