Provider Demographics
NPI:1679009443
Name:KRAFF, ERIC MARCUS (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MARCUS
Last Name:KRAFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SETTLERS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1622
Mailing Address - Country:US
Mailing Address - Phone:813-598-8532
Mailing Address - Fax:
Practice Address - Street 1:3800 FAIRFAX DR STE 1
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1703
Practice Address - Country:US
Practice Address - Phone:703-522-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0618002566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program