Provider Demographics
NPI:1356076970
Name:KACO OCULAR PROSTHETICS LLC
Entity Type:Organization
Organization Name:KACO OCULAR PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-239-8821
Mailing Address - Street 1:1628 MCKUSICK LN
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1628 MCKUSICK LN
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4620
Practice Address - Country:US
Practice Address - Phone:978-239-8821
Practice Address - Fax:859-217-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment