Provider Demographics
NPI:1871193904
Name:KMW VISION, LLC
Entity type:Organization
Organization Name:KMW VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRENNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-346-9549
Mailing Address - Street 1:285 CENTENNIAL OLYMPIC PARK DR NW UNIT 1704
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1851
Mailing Address - Country:US
Mailing Address - Phone:314-346-9549
Mailing Address - Fax:
Practice Address - Street 1:150 COBB PKWY S
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9209
Practice Address - Country:US
Practice Address - Phone:770-499-8332
Practice Address - Fax:770-499-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty