1073837464 NPI number — EYECARE ASSOCIATES OF OSAWATOMIE, P.A.

Table of content: (NPI 1073837464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073837464 NPI number — EYECARE ASSOCIATES OF OSAWATOMIE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE ASSOCIATES OF OSAWATOMIE, 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:
1073837464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSAWATOMIE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66064-0456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-256-2176
Provider Business Mailing Address Fax Number:
913-755-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 BROWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAWATOMIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66064-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-256-2176
Provider Business Practice Location Address Fax Number:
913-755-2787
Provider Enumeration Date:
03/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BURCHETT
Authorized Official First Name:
KARI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OPTOMETRIS/ DOCTOR
Authorized Official Telephone Number:
913-256-2176

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1713 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 12532 , 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: 11942 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 410020656 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: KA1721 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100218260A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00355811 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200357920A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410014216 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: CA0104 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 650544 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: DQ3063 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100218090A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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