Healthcare Provider Details

I. General information

NPI: 1578854451
Provider Name (Legal Business Name): FAMILY EYECARE CENTER LANSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CENTRE DR
LANSING KS
66043-6352
US

IV. Provider business mailing address

301 CENTRE DR
LANSING KS
66043-6352
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2020
  • Fax: 913-682-2999
Mailing address:
  • Phone: 913-682-2020
  • Fax: 913-682-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1849
License Number StateKS

VIII. Authorized Official

Name: MS. KELLY WAGNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-682-2929