Healthcare Provider Details

I. General information

NPI: 1861458820
Provider Name (Legal Business Name): BRIAN SCOTT MCDONALD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15208 S BLACKBOB RD
OLATHE KS
66062-3316
US

IV. Provider business mailing address

15052 S BLACKBOB RD
OLATHE KS
66062-2663
US

V. Phone/Fax

Practice location:
  • Phone: 913-390-4900
  • Fax: 913-390-4970
Mailing address:
  • Phone: 913-390-4900
  • Fax: 913-390-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1660
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: