Healthcare Provider Details

I. General information

NPI: 1477591568
Provider Name (Legal Business Name): EYECARE ASSOCIATES OF OSAWATOMIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 BROWN AVE
OSAWATOMIE KS
66064-1322
US

IV. Provider business mailing address

PO BOX 456
OSAWATOMIE KS
66064-0456
US

V. Phone/Fax

Practice location:
  • Phone: 913-256-2176
  • Fax: 913-755-2787
Mailing address:
  • Phone: 913-256-2176
  • Fax: 913-755-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS KATHY J JAMES
Title or Position: BILLING CLERK
Credential:
Phone: 913-256-2176