Provider Demographics
NPI:1043258668
Name:KAMNETZ, GREGG EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:EDWARD
Last Name:KAMNETZ
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 1:2712 BEE CAVE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5676
Mailing Address - Country:US
Mailing Address - Phone:512-327-3605
Mailing Address - Fax:512-327-3803
Practice Address - Street 1:2712 BEE CAVE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5676
Practice Address - Country:US
Practice Address - Phone:512-327-3605
Practice Address - Fax:512-327-3803
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3486TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127227003Medicaid
TXTXB150070Medicare PIN
TX127227003Medicaid
TX00E11RMedicare ID - Type Unspecified