Provider Demographics
NPI:1316914039
Name:GERMAN, GREGG ALLEN (OD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:ALLEN
Last Name:GERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0418
Mailing Address - Country:US
Mailing Address - Phone:661-328-7738
Mailing Address - Fax:661-325-2731
Practice Address - Street 1:4900 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0418
Practice Address - Country:US
Practice Address - Phone:661-328-7738
Practice Address - Fax:661-325-2731
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06034T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T10209Medicare UPIN
CASD0060340Medicare PIN
CAEB964ZMedicare PIN
CA1316914039Medicare UPIN