MEDICARE: DR. TIMOTHY P KRET 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
1	152W00000X	Optometrist	2288TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	2288TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	80813Q	OTHER	TX	BCBS GROUP #0058FC
3	4502490	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1669475182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY P KRET O.D.

Provider Business Mailing Address
First Line	:	4825 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4150
Country	:	US
Telephone Number	:	817-731-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4150
Country	:	US
Telephone Number	:	817-731-4646
Fax Number	:	817-731-4646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	08/30/2016

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