MEDICARE: DR. TERRY FOSTER HAWKS O.D.

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	1055-3	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770569345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY FOSTER HAWKS O.D.

Provider Business Mailing Address
First Line	:	5703 W 95TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66207-2919
Country	:	US
Telephone Number	:	913-341-4508
Fax Number	:	913-341-4570

Provider Business Practice Location Address
First Line	:	5703 W 95TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66207-2919
Country	:	US
Telephone Number	:	913-341-4508
Fax Number	:	913-341-4570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	12/21/2011

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