MEDICARE: KNK VISION CORP

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	156F00000X	Technician/Technologist		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08771	OTHER	PA	SPECTERA
2	202405	OTHER	PA	OPTI-CHOICE

General Provider Information

NPI Number	:	1700098555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNK VISION CORP

Provider Business Mailing Address
First Line	:	205 MONTGOMERY MALL
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3905
Country	:	US
Telephone Number	:	215-362-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 MONTGOMERY MALL
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3905
Country	:	US
Telephone Number	:	215-362-2422
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GARY KASCHAK
Credential	:
Telephone Number	:	215-362-2422

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/21/2022

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Directions to “KNK VISION CORP ” Practice Location

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