Provider Demographics
NPI:1780853002
Name:GEORGE J. KAKNIS, OD
Entity Type:Organization
Organization Name:GEORGE J. KAKNIS, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAKNIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-896-2017
Mailing Address - Street 1:1054 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1792
Mailing Address - Country:US
Mailing Address - Phone:845-896-2017
Mailing Address - Fax:845-897-5702
Practice Address - Street 1:1054 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1792
Practice Address - Country:US
Practice Address - Phone:845-896-2017
Practice Address - Fax:845-897-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0749460001Medicare NSC