Provider Demographics
NPI:1225062656
Name:KAMENS, GARY HIRAM (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HIRAM
Last Name:KAMENS
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 1:378 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5917
Mailing Address - Country:US
Mailing Address - Phone:508-761-5034
Mailing Address - Fax:508-761-5054
Practice Address - Street 1:378 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5917
Practice Address - Country:US
Practice Address - Phone:508-761-5034
Practice Address - Fax:508-761-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT59314Medicare UPIN