1659379782 NPI number — DR. NORMAN MILES KAHN O.D.

Table of content: (NPI 1922110378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659379782 NPI number — DR. NORMAN MILES KAHN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAHN
Provider First Name:
NORMAN
Provider Middle Name:
MILES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659379782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
04/05/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17835 FOREST RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-385-8855
Provider Business Mailing Address Fax Number:
434-385-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17835 FOREST RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FOREST
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24551-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-385-8855
Provider Business Practice Location Address Fax Number:
434-385-7575
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000177 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 0618000177 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 0618000177 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010105994 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 337983 . This is a "ANTHEM BLUE CROSS BLUE SHILE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 015346540 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015346558 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: VA0903 . This is a "EYEMED" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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