Healthcare Provider Details

I. General information

NPI: 1811845696
Provider Name (Legal Business Name): JENNIFER MARIE FAUTH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 BROADMOOR ST
MISSION KS
66202-3229
US

IV. Provider business mailing address

6100 BROADMOOR ST
MISSION KS
66202-3229
US

V. Phone/Fax

Practice location:
  • Phone: 913-553-6330
  • Fax:
Mailing address:
  • Phone: 913-553-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2270
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: