Provider Demographics
NPI:1912300443
Name:KAHOKA FAMILY EYEWEAR LLC
Entity Type:Organization
Organization Name:KAHOKA FAMILY EYEWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-727-2700
Mailing Address - Street 1:450 N JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445-1427
Mailing Address - Country:US
Mailing Address - Phone:660-727-2705
Mailing Address - Fax:
Practice Address - Street 1:450 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445-1427
Practice Address - Country:US
Practice Address - Phone:660-727-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier