MEDICARE: K & K OPTICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	MM002314	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MM002314	OTHER	MI	OPTEMETRIC LISCENSE

General Provider Information

NPI Number	:	1225113863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K & K OPTICAL INC

Provider Business Mailing Address
First Line	:	28209 7 MILE RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-3750
Country	:	US
Telephone Number	:	248-777-2830
Fax Number	:	248-777-9376

Provider Business Practice Location Address
First Line	:	28209 7 MILE RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-3750
Country	:	US
Telephone Number	:	248-777-2830
Fax Number	:	248-777-9376

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIM KLOSOWSKI
Credential	:
Telephone Number	:	248-777-2830

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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Directions to “K & K OPTICAL INC ” Practice Location

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