1053196428 NPI number — KC OCULAR AND FACIAL PROSTHETICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053196428 NPI number — KC OCULAR AND FACIAL PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KC OCULAR AND FACIAL PROSTHETICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KC OCULAR AND FACIAL PROSTHETICS CO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053196428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5424 STATE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66102-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-626-4980
Provider Business Mailing Address Fax Number:
913-365-6165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5424 STATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-626-4980
Provider Business Practice Location Address Fax Number:
913-423-3221
Provider Enumeration Date:
08/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
COMEAU
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-626-4980

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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