Healthcare Provider Details

I. General information

NPI: 1578467288
Provider Name (Legal Business Name): HEARTLAND RETINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE MULBERRY ST STE 101
LEES SUMMIT MO
64086-6016
US

IV. Provider business mailing address

301 NE MULBERRY ST STE 101
LEES SUMMIT MO
64086-6016
US

V. Phone/Fax

Practice location:
  • Phone: 816-727-2050
  • Fax: 816-727-2009
Mailing address:
  • Phone: 816-727-2050
  • Fax: 816-727-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AJAY SINGH
Title or Position: OWNER
Credential: MD
Phone: 816-727-2050