Individual
DR. KEVIN J GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O. D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618-000057
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012848001
DME POINT OF SERVICE
VA
01
—
038113
ANTHEM
VA
01
—
22-00047
UNITED HEALTHCARE
—
01
—
586486
US HEALTHCARE
—
05
—
89-2028-1
—
VA
Enumeration date
06/17/2005
Last updated
04/28/2011
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