=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487837050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRASEMANN EYE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2007
-----------------------------------------------------
Last Update Date | 12/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8003 E APACHE TRL
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85207-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-986-1601
-----------------------------------------------------
Fax | 480-986-9242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8003 E APACHE TRL
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85207-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-986-1601
-----------------------------------------------------
Fax | 480-986-9242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK ALAN KRASEMANN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 480-986-1601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 841
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------