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Contact Information

KEVIN R KICKHAM LLC
1308 E BATTLEFIELD
SPRINGFIELD, MO65804
 Phone: 417-890-7599
 Fax: 417-886-6484
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for KEVIN R KICKHAM LLC

NPI Number 1548476344
LBN Legal business name KEVIN R KICKHAM LLC
Authorized official KEVIN KICKHAM - (OPTOMETRIST OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/16/2007
Last updated 02/05/2016 - About 10 years ago
Identifiers
MO License # T02770
MO Medicaid 315387803
MO Other 000014298 MEDICARE PTAN
MO Other P00256828 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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