Provider Demographics
NPI:1083845655
Name:KRULISKY, MARK E
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:KRULISKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-4040
Mailing Address - Country:US
Mailing Address - Phone:504-885-2880
Mailing Address - Fax:504-885-2980
Practice Address - Street 1:2016 CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2411
Practice Address - Country:US
Practice Address - Phone:504-885-2880
Practice Address - Fax:504-885-2980
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician