Provider Demographics
NPI:1770503088
Name:KRASNICKE, ANTHONY A (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:KRASNICKE
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 1:547 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5810
Mailing Address - Country:US
Mailing Address - Phone:610-866-5815
Mailing Address - Fax:610-866-2450
Practice Address - Street 1:547 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5810
Practice Address - Country:US
Practice Address - Phone:610-866-5815
Practice Address - Fax:610-866-2450
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000045152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0051223000OtherINDEPENDENCE BLUE CROSS
PAKR287711OtherHIGHMARK BLUE SHIELD
5324073OtherAETNA
PA50009423OtherCAPITAL BLUE CROSS/CAIC
5324073OtherAETNA
PAKR287711OtherHIGHMARK BLUE SHIELD