Provider Demographics
NPI:1669475182
Name:KRET, TIMOTHY P (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:KRET
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 1:4825 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4150
Mailing Address - Country:US
Mailing Address - Phone:817-731-4646
Mailing Address - Fax:
Practice Address - Street 1:4825 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4150
Practice Address - Country:US
Practice Address - Phone:817-731-4646
Practice Address - Fax:817-731-4646
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2288TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0934564Medicaid
TX80813QOtherBCBS GROUP #0058FC
TX4502490OtherAETNA
TX80813QOtherBCBS GROUP #0058FC
TX4502490OtherAETNA