Provider Demographics
NPI:1215902341
Name:TRAINOR, KEVIN M
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:TRAINOR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:M
Other - Last Name:TRAINOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1172 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125
Mailing Address - Country:US
Mailing Address - Phone:408-283-7100
Mailing Address - Fax:408-283-7103
Practice Address - Street 1:1172 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-283-7100
Practice Address - Fax:408-283-7103
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9452T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05960ZOtherGROUP PTAN
CASD0094520OtherINDIVIDUAL PTAN
CASD0094520OtherINDIVIDUAL PTAN