Healthcare Provider Details

I. General information

NPI: 1952535353
Provider Name (Legal Business Name): SEAN MATTHEW GRATTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 NALL AVE
LEAWOOD KS
66211-1669
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 913-261-2020
  • Fax:
Mailing address:
  • Phone: 816-218-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2014018808
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number2014018808
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: