Provider Demographics
NPI:1558674879
Name:K'S OPTICAL
Entity Type:Organization
Organization Name:K'S OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:HANIF
Authorized Official - Last Name:PERACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-242-2726
Mailing Address - Street 1:725 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2936
Mailing Address - Country:US
Mailing Address - Phone:734-242-2726
Mailing Address - Fax:734-242-2745
Practice Address - Street 1:725 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2936
Practice Address - Country:US
Practice Address - Phone:734-242-2726
Practice Address - Fax:734-242-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6455560001Medicare NSC