Healthcare Provider Details

I. General information

NPI: 1972553071
Provider Name (Legal Business Name): SENIOR VISION SERVICES OF KANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD
OMAHA NE
68124-1900
US

IV. Provider business mailing address

PO BOX 30128
OMAHA NE
68103-1228
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-3232
  • Fax: 402-898-3234
Mailing address:
  • Phone: 402-898-3232
  • Fax: 402-898-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1539
License Number StateKS

VIII. Authorized Official

Name: LYNDON GRAVES
Title or Position: OWNER
Credential: O.D.
Phone: 402-898-3232