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General NPI Number Information
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NPI Number | 1780696369
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Entity Type | Individual
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Provider Name | LARRY J KRAUSE O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 149 MIDWAY BLVD
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City | ELYRIA
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State | OH
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Zip | 44035-2780
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Country | US
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Telephone | 440-324-4289
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Fax |
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Provider Business Mailing Address
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Address Line | 2034 RESERVE CIR S
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City | LORAIN
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State | OH
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Zip | 44053-3086
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Country | US
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Telephone | 440-960-1198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3105
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License Number State | OH
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