Doctor Name: | KEVIN ALAN GREENE |
NPI Number: | 1013293257 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | 7991 |
Business Practice Address: | 210 Cornelia St Suite 302 Plattsburgh, NY - 129012318 |
Business Phone Number: | 5155618820 |
Business Fax Number: | |
Mailing Address: | Po Box 176, 56 Lake St PORT KENT |
State: | NY |
Postal Code: | 129750176 |
Phone Number: | 5185780425 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2011 |
NPI Last Update Date: | 11/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 7991 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |