1902899255 NPI number — KIAN M KAZ MD EYE PHYSICIAN & SURGEON PC

Table of content: (NPI 1902899255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902899255 NPI number — KIAN M KAZ MD EYE PHYSICIAN & SURGEON PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIAN M KAZ MD EYE PHYSICIAN & SURGEON PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902899255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12690 MCMANUS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23602-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-875-7700
Provider Business Mailing Address Fax Number:
757-875-7721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12690 MCMANUS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23602-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-875-7700
Provider Business Practice Location Address Fax Number:
757-875-7721
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAZ
Authorized Official First Name:
KIAN
Authorized Official Middle Name:
MONICA
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
757-875-7700

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0101058286 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006305750 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 464665 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 026179 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 117671 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 52357 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com