MEDICARE: DR. JEFFREY KRAUSHAAR O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV004145-1	NY

General Provider Information

NPI Number	:	1700860269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY KRAUSHAAR O.D.

Provider Business Mailing Address
First Line	:	45 ROUTE 25A
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1389
Country	:	US
Telephone Number	:	631-821-2244
Fax Number	:	631-821-4228

Provider Business Practice Location Address
First Line	:	45 ROUTE 25A
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1389
Country	:	US
Telephone Number	:	631-821-2244
Fax Number	:	631-821-4228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/06/2008

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