KSB Medical Group, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

KSB MEDICAL GROUP, INC.

Doing business as

KSB Eye & Vision Care

Practice address

511 Palmyra St
Dixon, IL 61021-1953

Phone

(815) 284-2020

Fax

(815) 284-8326

NPI assigned

Jun 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Austin Bruce Frazier

Title

Cfo

Phone

(815) 285-5513

Specialties & licenses 1

Addresses

Other names 1

• KSB Eye & Vision Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672272000000",
    "number": "1487975603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841330",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641841330",
            "telephone_number": "816-201-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 PALMYRA ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211953",
            "telephone_number": "815-284-2020",
            "fax_number": "815-284-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSB MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-22",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-27",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "815-285-5513"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KSB Eye & Vision Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KSB Eye & Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Lynn Krick
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• Eyewear Supplier in Dixon, IL
• Providers in Dixon, IL by specialty
• Eyewear Supplier in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.