MEDICARE: NITSCHKE EYE CARE, PA

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	152W00000X	Optometrist	1407	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27968014	OTHER	KS	BLUE CROSS BLUE SHIELD GP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	20417050	OTHER	KS	BCBS OF KANSAS CITY IND.

General Provider Information

NPI Number	:	1184834491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NITSCHKE EYE CARE, PA

Provider Business Mailing Address
First Line	:	13025 KANSAS AVE
Second Line	:
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-9206
Country	:	US
Telephone Number	:	913-422-7781
Fax Number	:	913-422-7796

Provider Business Practice Location Address
First Line	:	13025 KANSAS AVE
Second Line	:
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-9206
Country	:	US
Telephone Number	:	913-422-7781
Fax Number	:	913-422-7796

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DARIN L NITSCHKE
Credential	:	O.D.
Telephone Number	:	913-422-7781

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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Directions to “NITSCHKE EYE CARE, PA ” Practice Location

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