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General NPI Number Information
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NPI Number | 1316915721
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Entity Type | Organization
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Legal Business Name | E L KOMRAUS OD INC
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 7509 E MAIN ST
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-7268
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Country | US
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Telephone | 614-866-6040
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Fax | 614-866-7714
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Provider Business Mailing Address
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Address Line | 7509 E MAIN ST
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-7268
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Country | US
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Telephone | 614-866-6040
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Fax | 614-866-7714
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDMUND L KOMRAUS
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Credential | OD
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Telephone | 614-866-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2662
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License Number State | OH
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