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Organization

KSB MEDICAL GROUP, INC.

Active
Other names
KSB Optical
Organization subpart
No

Provider details

NPI number
Authorized official
AUSTIN BRUCE FRAZIER (CFO)
(815) 285-5513
Entity
Organization

Contact information

Practice address
511 PALMYRA ST, DIXON, IL 61021-1953
(815) 284-2020
Mailing address
PO BOX 841330, KANSAS CITY, MO 64184-1330
(816) 201-3331

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0169800003
MEDICARE DMEPOS NUMBER
Enumeration date
03/10/2006
Last updated
12/29/2022
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