Provider Demographics
NPI:1962412783
Name:KAHN, BRIAN A (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:KAHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4386
Mailing Address - Country:US
Mailing Address - Phone:770-995-5408
Mailing Address - Fax:770-513-2042
Practice Address - Street 1:3120 MAPLE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2608
Practice Address - Country:US
Practice Address - Phone:404-233-3267
Practice Address - Fax:404-233-4399
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00342584OtherRAILROAD MEDICARE
P00342584OtherRAILROAD MEDICARE
GAU20291Medicare UPIN