Provider Demographics
NPI:1083588990
Name:K&R OPTICAL SOLUTIONS CORPORATION
Entity type:Organization
Organization Name:K&R OPTICAL SOLUTIONS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-207-5085
Mailing Address - Street 1:3304 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3304 8TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4755
Practice Address - Country:US
Practice Address - Phone:601-207-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K&R OPTICAL SOLUTIONS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS005986512Medicaid