Provider Demographics
NPI:1902899255
Name:KIAN M KAZ MD EYE PHYSICIAN & SURGEON PC
Entity Type:Organization
Organization Name:KIAN M KAZ MD EYE PHYSICIAN & SURGEON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIAN
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:KAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-875-7700
Mailing Address - Street 1:12690 MCMANUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4433
Mailing Address - Country:US
Mailing Address - Phone:757-875-7700
Mailing Address - Fax:757-875-7721
Practice Address - Street 1:12690 MCMANUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4433
Practice Address - Country:US
Practice Address - Phone:757-875-7700
Practice Address - Fax:757-875-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058286207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006305750Medicaid
VA464665OtherMAMSI
VA026179OtherCIGNA
VA117671OtherANTHEM BCBS
VA52357OtherOPTIMA HEALTH
VA=========OtherTIN
VAG54101Medicare UPIN
VA464665OtherMAMSI
VA52357OtherOPTIMA HEALTH