Provider Demographics
NPI:1851523963
Name:KAMENEV, MILA (OD)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:KAMENEV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAVENDER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4038
Mailing Address - Country:US
Mailing Address - Phone:201-779-3582
Mailing Address - Fax:
Practice Address - Street 1:4605 BARRANCA PKWY STE 430
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4767
Practice Address - Country:US
Practice Address - Phone:949-733-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00620600152W00000X
CA14810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist