Provider Demographics
NPI:1952440158
Name:KRASKOWSKY, GREGORY ALEXANDER (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALEXANDER
Last Name:KRASKOWSKY
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 1:3201 DANVILLE BLVD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 DANVILLE BLVD
Practice Address - Street 2:SUITE 165
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1938
Practice Address - Country:US
Practice Address - Phone:925-820-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80698Medicare UPIN