Provider Demographics
NPI:1205588068
Name:KB VISION LLC
Entity type:Organization
Organization Name:KB VISION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-208-1389
Mailing Address - Street 1:5980 NEAL AVE N STE 500
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2195
Mailing Address - Country:US
Mailing Address - Phone:541-208-1389
Mailing Address - Fax:
Practice Address - Street 1:5980 NEAL AVE N STE 500
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-2195
Practice Address - Country:US
Practice Address - Phone:651-208-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier