Basic Information
| Provider Information | |||||||||
| NPI: | 1285777151 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOWARD R. KRAUSS, M.D. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHERN CALIFORNIA NEUROOPHTHALMOLOGY AND ORBITAL SURGICAL ASSOCIATIO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11645 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104775558 | ||||||||
| FaxNumber: | 3104777281 | ||||||||
| Practice Location | |||||||||
| Address1: | 11645 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104775558 | ||||||||
| FaxNumber: | 3104777281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | KRAUSS | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3104775558 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | G37539 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180036978 | 01 | CA | RAILROAD MEDICARE | OTHER | GR0047880 | 05 | CA | MEDICAID |