Healthcare Provider Details

I. General information

NPI: 1255306189
Provider Name (Legal Business Name): BARBARA D WOLOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 W 151ST ST
OLATHE KS
66061-7200
US

IV. Provider business mailing address

PO BOX 219241
KANSAS CITY MO
64121-9241
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-5511
  • Fax: 913-829-5571
Mailing address:
  • Phone: 913-829-5511
  • Fax: 913-829-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0423830
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR3P32
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: