Healthcare Provider Details

I. General information

NPI: 1336348820
Provider Name (Legal Business Name): JOHANN GEORG OHLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 ANTIOCH RD
OVERLAND PARK KS
66204-2622
US

IV. Provider business mailing address

7504 ANTIOCH RD
OVERLAND PARK KS
66204-2622
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-3100
  • Fax: 913-341-6818
Mailing address:
  • Phone: 913-341-3100
  • Fax: 913-341-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: