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NPI Code Detail

MEDICARE: DR. KEVIN JOHN GERMUNDSEN O.D.

MEDICARE:  DR. KEVIN JOHN GERMUNDSEN  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
1152W00000XOptometrist8977TCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ02299ZOTHERCABLUE SHIELD OF CA
28977TOTHERCABLUE CROSS OF CA

General Provider Information

NPI Number : 1780702258
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN JOHN GERMUNDSEN O.D.
Provider Business Mailing Address
First Line : 10088 ADAMS AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-4905
Country : US
Telephone Number : 714-962-9377
Fax Number : 714-593-1237
Provider Business Practice Location Address
First Line : 10088 ADAMS AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-4905
Country : US
Telephone Number : 714-962-9377
Fax Number : 714-593-1237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 04/10/2008

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