Healthcare Provider Details

I. General information

NPI: 1497382204
Provider Name (Legal Business Name): LIMESTONE EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 W 6TH STREET SUITE 103
LAWRENCE KS
66049
US

IV. Provider business mailing address

4320 W 6TH STREET SUITE 103
LAWRENCE KS
66049
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-1242
  • Fax: 785-842-3557
Mailing address:
  • Phone: 785-842-1242
  • Fax: 785-842-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JACOB WILLIAM LETOURNEAU
Title or Position: OWNER
Credential: OD
Phone: 785-842-1242