Provider Demographics
NPI:1568062248
Name:KRUPA TAILOR OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KRUPA TAILOR OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRUPA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-219-0314
Mailing Address - Street 1:217 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4716
Mailing Address - Country:US
Mailing Address - Phone:831-724-3823
Mailing Address - Fax:831-724-2605
Practice Address - Street 1:217 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4716
Practice Address - Country:US
Practice Address - Phone:831-724-3823
Practice Address - Fax:831-724-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty