Provider Demographics
NPI:1992495105
Name:FARAG, KAMMNA B
Entity type:Individual
Prefix:
First Name:KAMMNA
Middle Name:B
Last Name:FARAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3110
Mailing Address - Country:US
Mailing Address - Phone:863-815-4408
Mailing Address - Fax:863-815-4599
Practice Address - Street 1:5800 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3110
Practice Address - Country:US
Practice Address - Phone:863-815-4408
Practice Address - Fax:863-815-4599
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6208156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician