1649290255 NPI number — HEART OF AMERICA EYE CARE PA

Table of content: (NPI 1649290255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649290255 NPI number — HEART OF AMERICA EYE CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF AMERICA EYE CARE 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:
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:
1649290255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10985 CODY ST STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210-1243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-492-0021
Provider Business Mailing Address Fax Number:
913-492-0093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10985 CODY ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-492-0021
Provider Business Practice Location Address Fax Number:
913-492-0093
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KWAPISZESKI
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
913-362-3210

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0417539 , 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: 23482016 . This is a "BCBS KC GR NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".