Healthcare Provider Details

I. General information

NPI: 1437566189
Provider Name (Legal Business Name): KJK VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 W PINERIDGE DR
SIOUX FALLS SD
57107-0960
US

IV. Provider business mailing address

5824 W PINERIDGE DR
SIOUX FALLS SD
57107-0960
US

V. Phone/Fax

Practice location:
  • Phone: 605-360-5627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number706
License Number StateSD

VIII. Authorized Official

Name: KACIE KREIFELS
Title or Position: ADMINISTRATOR
Credential: O.D, M.S
Phone: 605-360-5627