=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730866203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLAN JACOB KRAUSZ OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2023
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7880 OLD MADISON PIKE
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-728-7112
-----------------------------------------------------
Fax | 256-772-8738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15933 CLAYTON RD STE 210
-----------------------------------------------------
City | BALLWIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-200-7393
-----------------------------------------------------
Fax | 636-527-0766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S-F23-TA-D02
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------