Healthcare Provider Details

I. General information

NPI: 1992447163
Provider Name (Legal Business Name): 1619 INVESTMENTS DBA MILLS OPTOMETRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 MARSHALL DR
LENEXA KS
66215-3845
US

IV. Provider business mailing address

11619 TOMAHAWK CREEK PKWY APT B
LEAWOOD KS
66211-2640
US

V. Phone/Fax

Practice location:
  • Phone: 913-227-3706
  • Fax: 913-227-3727
Mailing address:
  • Phone: 816-797-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BRENDA JOY VANDEN HULL
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-963-0245