Healthcare Provider Details

I. General information

NPI: 1942413208
Provider Name (Legal Business Name): MR. CHARLES C. KRAINZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WINCHESTER ST
SARDINIA OH
45171-0064
US

IV. Provider business mailing address

PO BOX 64 101 WINCHESTER ST
SARDINIA OH
45171-0064
US

V. Phone/Fax

Practice location:
  • Phone: 937-446-9090
  • Fax:
Mailing address:
  • Phone: 937-446-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberS. 4087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: