Provider Demographics
NPI:1649300468
Name:ESCONDIDO OPTICAL
Entity type:Organization
Organization Name:ESCONDIDO OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:KRAUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-746-3937
Mailing Address - Street 1:810 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3421
Mailing Address - Country:US
Mailing Address - Phone:760-746-3937
Mailing Address - Fax:760-746-3991
Practice Address - Street 1:810 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3421
Practice Address - Country:US
Practice Address - Phone:760-746-3937
Practice Address - Fax:760-746-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1150610001Medicare NSC