Provider Demographics
NPI:1659379782
Name:KAHN, NORMAN MILES (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:MILES
Last Name:KAHN
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 1:17835 FOREST RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4043
Mailing Address - Country:US
Mailing Address - Phone:434-385-8855
Mailing Address - Fax:434-385-7575
Practice Address - Street 1:17835 FOREST RD
Practice Address - Street 2:SUITE B
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4043
Practice Address - Country:US
Practice Address - Phone:434-385-8855
Practice Address - Fax:434-385-7575
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-04-19
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
VA0618000177152W00000X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010105994Medicaid
VA337983OtherANTHEM BLUE CROSS BLUE SHILE
VA015346540Medicaid
VA015346558Medicaid
VAVA0903OtherEYEMED
VAT21556Medicare UPIN
VA018148G31Medicare PIN
VA015346558Medicaid