Provider Demographics
NPI:1003811605
Name:KAMINSKI, JOHN EARL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EARL
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 HARCREST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4717
Mailing Address - Country:US
Mailing Address - Phone:989-636-7580
Mailing Address - Fax:989-636-7583
Practice Address - Street 1:1504 HARCREST DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4717
Practice Address - Country:US
Practice Address - Phone:989-636-7580
Practice Address - Fax:989-636-7583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004014152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N70840Medicare ID - Type Unspecified