Provider Demographics
NPI:1487837050
Name:KRASEMANN EYE CENTER INC
Entity Type:Organization
Organization Name:KRASEMANN EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KRASEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-986-1601
Mailing Address - Street 1:8003 E APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-8503
Mailing Address - Country:US
Mailing Address - Phone:480-986-1601
Mailing Address - Fax:480-986-9242
Practice Address - Street 1:8003 E APACHE TRL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-8503
Practice Address - Country:US
Practice Address - Phone:480-986-1601
Practice Address - Fax:480-986-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ841261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1245610Medicaid
U38114Medicare UPIN