Healthcare Provider Details

I. General information

NPI: 1376893362
Provider Name (Legal Business Name): EYRIE ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8502 N GREEN HILLS RD
KANSAS CITY MO
64154-1403
US

IV. Provider business mailing address

8502 N GREEN HILLS RD
KANSAS CITY MO
64154-1403
US

V. Phone/Fax

Practice location:
  • Phone: 816-741-3937
  • Fax: 816-741-8801
Mailing address:
  • Phone: 816-741-3937
  • Fax: 816-741-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. RANDAL SCOTT SMITH
Title or Position: PRESIDENT
Credential:
Phone: 816-741-3937