Healthcare Provider Details

I. General information

NPI: 1477511335
Provider Name (Legal Business Name): COKINGTIN EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/26/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ROCK HAVEN RD CASS MEDICAL CENTER
HARRISONVILLE MO
64701-4411
US

IV. Provider business mailing address

5520 COLLEGE BLVD STE 201
OVERLAND PARK KS
66211-1630
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-3737
  • Fax: 913-469-6686
Mailing address:
  • Phone: 913-491-3737
  • Fax: 913-469-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BALESTRIERI
Title or Position: CEO/PRACTICE ADMINISTRATOR
Credential:
Phone: 913-491-3737