Individual
DR. KENNETH ALLEN GREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1201 N BRIGHTLEAF BLVD, SMITHFIELD, NC 27577-4229
(919) 934-8152
(919) 934-8154
Mailing address
1201 N BRIGHTLEAF BLVD, SMITHFIELD, NC 27577-4229
(919) 934-8152
(919) 934-8154
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1133
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09345
BCBS PROV #
NC
05
—
7909345
—
NC
01
—
P00777283
RR MCARE
NC
Enumeration date
04/11/2006
Last updated
11/20/2014
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