1598930745 NPI number — CHILDREN'S EYE CARE, P.A.

Table of content: (NPI 1598930745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598930745 NPI number — CHILDREN'S EYE CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S EYE CARE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598930745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 W 109TH ST
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-491-9123
Provider Business Mailing Address Fax Number:
913-491-6608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 W 109TH ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-491-9123
Provider Business Practice Location Address Fax Number:
913-491-6608
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRAVERMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-491-9123

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0417188 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07379 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180012951 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200730638 . This is a "MISSOURI MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 4465821 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06907178 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0809553 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100124250C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4001325 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 461214 . This is a "CHILDRENS MERCY FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100124250C . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30991 . This is a "PRINCIPAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2343355017 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 446582 . This is a "CENTRAL STATES" identifier . This identifiers is of the category "OTHER".




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