Provider Demographics
NPI:1134317522
Name:DR. JOHN KAKNIS, O.D., P.C.
Entity type:Organization
Organization Name:DR. JOHN KAKNIS, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKNIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-561-3666
Mailing Address - Street 1:4 HUDSON VALLEY PROFESSIONAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-561-3666
Mailing Address - Fax:
Practice Address - Street 1:4 HUDSON VALLEY PROFESSIONAL PLAZA
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY410043515OtherMEDICARE RAIL ROAD
NY4295032OtherAETNA
NYP1971752OtherOXFORD
1134317522OtherNPI CORPORATE
NYC40521OtherMEDICARE PROF SEVICES
NY502105OtherAETNA HMO
NYC40521OtherBLUE CROSS BLUE SHIELD
NY597126OtherMVP
WCWT31Medicare PIN
NY4295032OtherAETNA
NYT89821Medicare UPIN