Provider Demographics
NPI:1316915721
Name:E L KOMRAUS OD INC
Entity type:Organization
Organization Name:E L KOMRAUS OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOMRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-866-6040
Mailing Address - Street 1:7509 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7268
Mailing Address - Country:US
Mailing Address - Phone:614-866-6040
Mailing Address - Fax:614-866-7714
Practice Address - Street 1:7509 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7268
Practice Address - Country:US
Practice Address - Phone:614-866-6040
Practice Address - Fax:614-866-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0540010001Medicare NSC
OH0157382Medicare ID - Type Unspecified
T46075Medicare UPIN