Provider Demographics
NPI:1326019019
Name:KAISER, GREG WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:WAYNE
Last Name:KAISER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1352 LOS OSOS VALLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402
Mailing Address - Country:US
Mailing Address - Phone:805-528-0606
Mailing Address - Fax:805-528-0608
Practice Address - Street 1:1352 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402
Practice Address - Country:US
Practice Address - Phone:805-528-0606
Practice Address - Fax:805-528-0608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6471T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0064711OtherMEDICAL
CASD0064711OtherMEDICAL
0P6471Medicare ID - Type Unspecified