Provider Demographics
NPI:1780696369
Name:KRAUSE, LARRY J (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:KRAUSE
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 1:2034 RESERVE CIR S
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3086
Mailing Address - Country:US
Mailing Address - Phone:440-960-1198
Mailing Address - Fax:
Practice Address - Street 1:149 MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2780
Practice Address - Country:US
Practice Address - Phone:440-324-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46709Medicare UPIN