Provider Demographics
NPI:1306478359
Name:K&R OPTICAL SOLUTIONS CORPORATION
Entity type:Organization
Organization Name:K&R OPTICAL SOLUTIONS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED SCREENER
Authorized Official - Phone:601-207-5085
Mailing Address - Street 1:3220 LAUDERDALE RD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39335-9639
Mailing Address - Country:US
Mailing Address - Phone:601-207-5085
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:386-343-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05986512Medicaid