Provider Demographics
NPI:1811961170
Name:KRAFT, ANDREW PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:KRAFT
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 1:409 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5814
Mailing Address - Country:US
Mailing Address - Phone:580-242-2020
Mailing Address - Fax:580-234-1699
Practice Address - Street 1:409 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5814
Practice Address - Country:US
Practice Address - Phone:580-242-2020
Practice Address - Fax:580-234-1699
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2321152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK743027540OtherVISION SERVICE PLAN
OK100847040AMedicaid
OKOKB5421Medicare PIN
OK800522057Medicare ID - Type Unspecified
OK100847040AMedicaid