MEDICARE: DOCTORS' OPTICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0414870	KS

General Provider Information

NPI Number	:	1134280027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS' OPTICAL

Provider Business Mailing Address
First Line	:	21 N 12TH ST
Second Line	:	SUITE 101
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-5161
Country	:	US
Telephone Number	:	913-342-4405
Fax Number	:	913-342-2241

Provider Business Practice Location Address
First Line	:	21 N 12TH ST
Second Line	:	SUITE 101
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-5161
Country	:	US
Telephone Number	:	913-342-4405
Fax Number	:	913-342-2241

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. KATHY MCCONNELL
Credential	:
Telephone Number	:	913-342-4405

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	10/17/2007

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