Healthcare Provider Details

I. General information

NPI: 1811845696
Provider Name (Legal Business Name): JENNIFER MARIE FAUTH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 63RD ST
KANSAS CITY MO
64110-3330
US

IV. Provider business mailing address

21020 W 151ST ST
OLATHE KS
66061-7200
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-5511
  • Fax: 913-322-1676
Mailing address:
  • Phone: 913-829-5511
  • Fax: 913-829-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2026012230
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: