Provider Demographics
NPI:1437566189
Name:KJK VISION LLC
Entity Type:Organization
Organization Name:KJK VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREIFELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS
Authorized Official - Phone:605-360-5627
Mailing Address - Street 1:5824 W PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-0960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5824 W PINERIDGE DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-0960
Practice Address - Country:US
Practice Address - Phone:605-360-5627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty