Provider Demographics
NPI:1922001445
Name:TIM P KRET OD, PA
Entity Type:Organization
Organization Name:TIM P KRET OD, PA
Other - Org Name:1ST EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-237-7153
Mailing Address - Street 1:3963 BOAT CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135
Mailing Address - Country:US
Mailing Address - Phone:817-237-7153
Mailing Address - Fax:817-237-7123
Practice Address - Street 1:3963 BOAT CLUB ROAD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135
Practice Address - Country:US
Practice Address - Phone:817-237-7153
Practice Address - Fax:817-237-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-30
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2288TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058FCOtherBCBS
TX1696338Medicaid
TX0586040001Medicare NSC
TX1696338Medicaid