Healthcare Provider Details

I. General information

NPI: 1235766908
Provider Name (Legal Business Name): SARA JOY KRACHMALNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 STATE LINE RD STE 100
PRAIRIE VILLAGE KS
66208-3447
US

IV. Provider business mailing address

7400 STATE LINE RD STE 202
PRAIRIE VILLAGE KS
66208-3445
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 913-588-6600
  • Fax: 913-588-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2024016919
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-51477
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number04-51477
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number2024016919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: