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General NPI Number Information
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NPI Number | 1538230685
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Entity Type | Organization
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Legal Business Name | K.M. ENTERPRISES, INC.
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 4871 W TAFT RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-4819
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Country | US
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Telephone | 315-451-4600
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Fax | 315-451-7710
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Provider Business Mailing Address
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Address Line | 4871 W TAFT RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-4819
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Country | US
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Telephone | 315-451-4600
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Fax | 315-451-7710
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD B. KRZYZAK
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Credential | O.D.
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Telephone | 315-451-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV004146
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License Number State | NY
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