Provider Demographics
NPI:1942672514
Name:KRAUS, BRENDA (ABOC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:KRAUS
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1364
Mailing Address - Country:US
Mailing Address - Phone:440-375-1016
Mailing Address - Fax:
Practice Address - Street 1:448 W MAIN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030
Practice Address - Country:US
Practice Address - Phone:440-375-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS4651156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician