Healthcare Provider Details

I. General information

NPI: 1083750384
Provider Name (Legal Business Name): OMNI EYE CENTERS OF KANSAS CITY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE MULBERRY ST. SUITE 101
LEE'S SUMMIT MO
64086-4533
US

IV. Provider business mailing address

301 NE MULBERRY ST. SUITE 101
LEE'S SUMMIT MO
64086-4533
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-3937
  • Fax:
Mailing address:
  • Phone: 816-525-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1478-3
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO3486
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN B GELVIN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 816-525-3937