Kickapoo Management LLC

NPI #1568849073 in Perry, Utah

Provider Information

NPI Number: 1568849073
Entity Type: Organization
Organization Name: Kickapoo Management LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 5, 2015
Last Updated: Jan 15, 2016

Practice Location

Address: 2480 S HIGHWAY 89
Address 2: SUITE B
City: Perry
State: Utah
ZIP Code: 84302-6727
Phone: (435) 239-8756

Authorized Official

Name: DR. PAUL E REED, O.D.
Title: MANAGING MEMBER
Phone: (435) 239-8756

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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