MEDICARE: TIM P KRET OD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2288TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0058FC	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922001445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM P KRET OD, PA

Provider Business Mailing Address
First Line	:	3963 BOAT CLUB ROAD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135
Country	:	US
Telephone Number	:	817-237-7153
Fax Number	:	817-237-7123

Provider Business Practice Location Address
First Line	:	3963 BOAT CLUB ROAD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135
Country	:	US
Telephone Number	:	817-237-7153
Fax Number	:	817-237-7123

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIM P KRET
Credential	:	OD
Telephone Number	:	817-237-7153

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	11/09/2011

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