Healthcare Provider Details

I. General information

NPI: 1417239229
Provider Name (Legal Business Name): INSIGHT VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 CHERRY LN
LENEXA KS
66220-9763
US

IV. Provider business mailing address

10123 CHERRY LN
LENEXA KS
66220-9763
US

V. Phone/Fax

Practice location:
  • Phone: 913-254-7456
  • Fax: 913-254-9613
Mailing address:
  • Phone: 913-254-7456
  • Fax: 913-254-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1792
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1794
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1792
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1794
License Number StateKS

VIII. Authorized Official

Name: JUSTIN WEIGEL
Title or Position: OWNER
Credential: OD
Phone: 913-254-7456