Organization
KEVIN R KICKHAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN ROBERT KICKHAM OD (OPTOMETRIST OWNER)
(417) 890-7599
Entity
Organization
Contact information
Practice address
1308 E BATTLEFIELD, SPRINGFIELD, MO 65804
(417) 890-7599
(417) 886-6484
Mailing address
1308 E BATTLEFIELD ST, SPRINGFIELD, MO 65804-3604
(417) 890-7599
(417) 886-6484
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02770
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014298
MEDICARE PTAN
MO
05
—
315387803
—
MO
01
—
P00256828
RAILROAD MEDICARE
MO
Enumeration date
05/16/2007
Last updated
02/05/2016
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