Provider Demographics
NPI:1134275704
Name:KITCHENER, GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:KITCHENER
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 1:8041 HOSBROOK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2989
Mailing Address - Country:US
Mailing Address - Phone:513-984-1176
Mailing Address - Fax:
Practice Address - Street 1:8041 HOSBROOK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2989
Practice Address - Country:US
Practice Address - Phone:513-984-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3294 T1659152W00000X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534771Medicare ID - Type Unspecified