Provider Demographics
NPI:1841294816
Name:KRAVITZ, ALLAN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PAUL
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1826 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2221
Mailing Address - Country:US
Mailing Address - Phone:718-359-2834
Mailing Address - Fax:718-539-7252
Practice Address - Street 1:1826 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2221
Practice Address - Country:US
Practice Address - Phone:718-359-2834
Practice Address - Fax:718-539-7252
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT97046Medicare UPIN