Provider Demographics
NPI:1649214826
Name:FEINERMAN, GREGG (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:FEINERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2716
Mailing Address - Country:US
Mailing Address - Phone:949-631-4780
Mailing Address - Fax:949-631-7854
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-631-4780
Practice Address - Fax:949-631-7854
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60533207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15427Medicare ID - Type Unspecified
CAG86981Medicare UPIN