1407905391 NPI number — K & K VISION, INC.

Table of content: (NPI 1407905391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407905391 NPI number — K & K VISION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K & K VISION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407905391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2024 FORD PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55116-1931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-698-2020
Provider Business Mailing Address Fax Number:
651-698-6918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2024 FORD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55116-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-698-2020
Provider Business Practice Location Address Fax Number:
651-698-6918
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARROTT
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECIALIST
Authorized Official Telephone Number:
651-698-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 540S6PE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01034910 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21-17309 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 540S9PE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 100864 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 102435 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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