Provider Demographics
NPI:1053307512
Name:KAKNIS, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KAKNIS
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 1:4 HUDSON VALLEY PROFESSIONAL PLZ
Mailing Address - Street 2:P.O. BOX 2147
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3101
Mailing Address - Country:US
Mailing Address - Phone:845-561-3666
Mailing Address - Fax:
Practice Address - Street 1:4 HUDSON VALLEY PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3101
Practice Address - Country:US
Practice Address - Phone:845-561-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004539-0152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY410043515OtherMEDICARE RAIL ROAD
NY0196240001OtherMEDICARE DURABLE MEDICAL
NY0196240001OtherMEDICARE NSC
NYC40521OtherMEDICARE
1134317522OtherCORPORATE NPI
NYC40521OtherMEDICARE
NY410043515OtherMEDICARE RAIL ROAD