Provider Demographics
NPI:1558685529
Name:JEFFREY L KRASKIN OD PC
Entity Type:Organization
Organization Name:JEFFREY L KRASKIN OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:KRASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-363-4450
Mailing Address - Street 1:4600 MASSACHUSETTS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2362
Mailing Address - Country:US
Mailing Address - Phone:202-363-4450
Mailing Address - Fax:202-363-4452
Practice Address - Street 1:4600 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2362
Practice Address - Country:US
Practice Address - Phone:202-363-4450
Practice Address - Fax:202-363-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP482261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCU62169Medicare UPIN
DC880255Medicare PIN