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General NPI Number Information
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NPI Number | 1871751511
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Entity Type | Organization
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Legal Business Name | K.S. OPTICAL GROUP, INC.
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1522 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19121-4340
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Country | US
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Telephone | 215-765-1234
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Fax | 215-765-2881
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Provider Business Mailing Address
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Address Line | 1522 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19121-4340
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Country | US
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Telephone | 215-765-1234
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Fax | 215-765-2881
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Authorized Official
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Title or Position | STORE MANAGER/ OPTICIAN
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Name | MR. LESLIE PINKNEY
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Credential | OPTICIAN
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Telephone | 215-765-1264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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