Healthcare Provider Details

I. General information

NPI: 1124419957
Provider Name (Legal Business Name): PRAIRIE VIEW EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 AMHERST AVE SUITE B
MANHATTAN KS
66503-3043
US

IV. Provider business mailing address

2900 AMHERST AVE SUITE B
MANHATTAN KS
66503-3043
US

V. Phone/Fax

Practice location:
  • Phone: 785-477-0861
  • Fax:
Mailing address:
  • Phone: 785-477-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1986
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1986
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1986
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1986
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1986
License Number StateKS

VII. Legacy identifiers

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

# 1
Identifier1003196882
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: DR. ANNIE MARIE MOSIER ESLIT
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 785-410-2992