Healthcare Provider Details

I. General information

NPI: 1255781647
Provider Name (Legal Business Name): KEVIN TOMASU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13440 ROE AVE
LEAWOOD KS
66209-3412
US

IV. Provider business mailing address

13440 ROE AVE
LEAWOOD KS
66209-3412
US

V. Phone/Fax

Practice location:
  • Phone: 316-213-1935
  • Fax:
Mailing address:
  • Phone: 316-213-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2039
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2039
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2039
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: