Healthcare Provider Details

I. General information

NPI: 1073557112
Provider Name (Legal Business Name): JANE WINKLER PHILBROOK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 ROE BLVD
ROELAND PARK KS
66205-2359
US

IV. Provider business mailing address

7161 STATE AVE PO BOX 12174
KANSAS CITY KS
66112-3001
US

V. Phone/Fax

Practice location:
  • Phone: 913-403-9013
  • Fax: 913-273-5444
Mailing address:
  • Phone: 913-299-3548
  • Fax: 913-299-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1338
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03004
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberT03004
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1338
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberT03004
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1338
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberT03004
License Number StateMO
# 8
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1338
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: