Provider Demographics
NPI:1710182878
Name:EYEOPENERZ
Entity Type:Organization
Organization Name:EYEOPENERZ
Other - Org Name:KLB INVESTMENTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:262-632-3939
Mailing Address - Street 1:334 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1029
Mailing Address - Country:US
Mailing Address - Phone:262-632-3939
Mailing Address - Fax:262-632-4040
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1029
Practice Address - Country:US
Practice Address - Phone:262-632-3939
Practice Address - Fax:262-632-4040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLB INVESTMENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-19
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty