Provider Demographics
NPI:1265682769
Name:GREGORY PAUL KRACHER, OD,LLC
Entity Type:Organization
Organization Name:GREGORY PAUL KRACHER, OD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KRACHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-662-6761
Mailing Address - Street 1:249 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5405
Mailing Address - Country:US
Mailing Address - Phone:301-662-6761
Mailing Address - Fax:
Practice Address - Street 1:249 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5405
Practice Address - Country:US
Practice Address - Phone:301-662-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6148090001Medicare NSC
MD137595Medicare PIN