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Active NPI 1568849073 Organization (Entity Type 2)

Kickapoo Management Llc

Eyewear Supplier • Perry, UT

About Kickapoo Management Llc NPI 1568849073 Summary

Kickapoo Management Llc is a verified healthcare organization specializing in Eyewear Supplier operating in Perry, UT. Located at 2480 S HIGHWAY 89, SUITE B, this facility provides patient care and medical services under National Provider Identifier (NPI) 1568849073.

Administrative operations and authorized compliance are overseen by Paul Reed (Managing Member).

The facility is associated with 3 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

2480 S Highway 89
Suite B

Perry, UT 843026727

Telephone 4352398756

Authorized Official Information

Authorized Contact Name

DR. Paul Reed , O.D.

Title / Role

Managing Member

Official Telephone

4352398756

Facility Classifications & Specialties

Eyewear Supplier Primary Taxonomy

NUCC Taxonomy Code: 332H00000X

An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

3 Linked
Dr. Paul Reed , OD NPI 1396792982

Optometrist

Perry, UT

View Practitioner Profile →
Dr. Craig Pew , OD NPI 1821393810

Optometrist

Centerville, UT

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active January 15, 2016

NPI status registered as active in NPPES database

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Updated Practice Location January 15, 2016

Registered at 2480 S HIGHWAY 89, SUITE B, PERRY, UT 843026727 (Tel: 4352398756)

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Updated Business Mailing Address January 15, 2016

Registered at 2480 S HIGHWAY 89, SUITE B, PERRY, UT 843026727 (Tel: 4352398756)

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Organization / Clinic Name Updated January 15, 2016

Operating as KICKAPOO MANAGEMENT LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 15, 2016

Eyewear Supplier

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Initial NPI Registration & Enumeration May 05, 2015

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

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NPI Organization Metadata

NPI Number: 1568849073
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: May 05, 2015
Last Update: January 15, 2016

Mailing Address

2480 S Highway 89, Suite B

Perry, UT 843026727

Phone: 4352398756

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.