1124043021 NPI number — DRS PRICE YOUNG ODLE & HORSCH PA

Table of content: (NPI 1124043021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124043021 NPI number — DRS PRICE YOUNG ODLE & HORSCH PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS PRICE YOUNG ODLE & HORSCH PA
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:
THE EYEDOCTORS
Provider Other Organization Name Type Code:
3
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:
1124043021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-7255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-200-4393
Provider Business Mailing Address Fax Number:
636-527-0766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 IOWA ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-200-4393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRUELOVE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-200-4393

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  KS1355 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1355 , 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: DF9773 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200655870C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200655870E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2006558700 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200655870B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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