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General NPI Number Information
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NPI Number | 1568062248
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Entity Type | Organization
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Legal Business Name | KRUPA TAILOR OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 217 E LAKE AVE
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City | WATSONVILLE
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State | CA
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Zip | 95076-4716
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Country | US
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Telephone | 831-724-3823
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Fax | 831-724-2605
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Provider Business Mailing Address
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Address Line | 217 E LAKE AVE
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City | WATSONVILLE
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State | CA
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Zip | 95076-4716
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Country | US
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Telephone | 831-724-3823
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Fax | 831-724-2605
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRUPA TAILOR
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Credential | O.D.
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Telephone | 847-219-0314
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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 |
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License Number State |
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