Healthcare Provider Details

I. General information

NPI: 1033162631
Provider Name (Legal Business Name): EYE SURGERY CENTER-NORTHLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 N OAK TRFY SUITE 124
KANSAS CITY MO
64155-2233
US

IV. Provider business mailing address

4801CLIFF AVE SUITE 100
INDEPENDENCE MO
64055
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1230
  • Fax: 816-350-4585
Mailing address:
  • Phone: 816-478-1230
  • Fax: 816-350-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number191
License Number StateMO

VIII. Authorized Official

Name: MELINDA HAMILTON
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 816-350-4536