Provider Demographics
NPI:1407836638
Name:KINARD, ERIC TEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TEAL
Last Name:KINARD
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 1:1137 CEDAR SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3592
Mailing Address - Country:US
Mailing Address - Phone:706-353-2119
Mailing Address - Fax:
Practice Address - Street 1:1137 CEDAR SHOALS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3592
Practice Address - Country:US
Practice Address - Phone:706-353-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA933152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1234960001OtherMEDICARE DMERC
GA1234960001OtherMEDICARE DMERC
GA41ZCBPLMedicare ID - Type Unspecified