1326284605 NPI number — FLORY OPTOMETRY, PA

Table of content: (NPI 1326284605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326284605 NPI number — FLORY OPTOMETRY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORY OPTOMETRY, 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:
1326284605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 BOB BILLINGS PKWY
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66049-2926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-749-1010
Provider Business Mailing Address Fax Number:
785-749-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 BOB BILLINGS PKWY
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-749-1010
Provider Business Practice Location Address Fax Number:
785-749-4441
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FLORY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
785-749-1010

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1236-3 , 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: 24966011 . This is a "BLUE CROSS AND BLUE SHIELD OF KANSAS CITY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 410014570 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: T67614 . This is a "HEALTHNET" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100218740B . This is a "CHILDREN'S MERCY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 022437 . This is a "BLUE CROSS AND BLUE SHIELD OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 7417 . This is a "COVENTRY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100218740B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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