Provider Demographics
NPI:1457450199
Name:KROKOS, SANDRA M (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:KROKOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1723
Mailing Address - Country:US
Mailing Address - Phone:570-421-3342
Mailing Address - Fax:570-421-8490
Practice Address - Street 1:29 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1723
Practice Address - Country:US
Practice Address - Phone:570-421-3342
Practice Address - Fax:570-421-8490
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-007541-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA443875QGEMedicare ID - Type Unspecified
PAU45580Medicare UPIN