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General NPI Number Information
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NPI Number | 1871193904
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Entity Type | Organization
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Legal Business Name | KMW VISION, LLC
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 150 COBB PKWY S
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City | MARIETTA
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State | GA
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Zip | 30060-9209
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Country | US
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Telephone | 770-499-8332
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Fax | 770-499-1809
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Provider Business Mailing Address
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Address Line | 285 CENTENNIAL OLYMPIC PARK DR NW UNIT 1704
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City | ATLANTA
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State | GA
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Zip | 30313-1851
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Country | US
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Telephone | 314-346-9549
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATRENNA MARIE WASHINGTON
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Credential | O.D.
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Telephone | 314-346-9549
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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 |
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License Number State |
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