Provider Demographics
NPI:1841520038
Name:KM VISION INC.
Entity type:Organization
Organization Name:KM VISION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-613-6409
Mailing Address - Street 1:3700 ATLANTA HIGHWAY 141 GEORGIA SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7420
Mailing Address - Country:US
Mailing Address - Phone:706-613-6409
Mailing Address - Fax:706-613-5514
Practice Address - Street 1:3700 ATLANTA HIGHWAY 141 GEORGIA SQUARE MALL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7420
Practice Address - Country:US
Practice Address - Phone:706-613-6409
Practice Address - Fax:706-613-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G708118Medicare PIN