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NPI Code Detail

MEDICARE: ELLIOT GREGORY KAMIN O.D.

MEDICARE: ELLIOT GREGORY KAMIN O.D.
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
1152W00000XOptometrist11363TCA

General Provider Information

NPI Number : 1033269683
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIOT GREGORY KAMIN O.D.
Provider Business Mailing Address
First Line : 1900 DAVIS ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-1209
Country : US
Telephone Number : 510-632-5210
Fax Number : 510-632-5704
Provider Business Practice Location Address
First Line : 1900 DAVIS ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-1209
Country : US
Telephone Number : 510-632-5210
Fax Number : 510-632-5704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 02/04/2021

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