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General NPI Number Information
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NPI Number | 1013532464
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Entity Type | Organization
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Legal Business Name | NOVACK VISION CARE, LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 1166 W 103RD ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-4511
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Country | US
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Telephone | 816-941-6886
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Fax | 816-941-8839
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Provider Business Mailing Address
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Address Line | 1166 W 103RD ST
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City | KANSAS CITY
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State | MO
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Zip | 64114-4511
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Country | US
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Telephone | 816-941-6886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL NOVACK
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Credential | OD
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Telephone | 816-550-8019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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