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General NPI Number Information
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NPI Number | 1073559274
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Entity Type | Individual
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Provider Name | MATTHEW PHILIP LAURIE O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 12120 S STRANG LINE RD
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City | OLATHE
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State | KS
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Zip | 66062-5219
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Country | US
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Telephone | 913-307-9200
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Fax | 913-307-9200
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Provider Business Mailing Address
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Address Line | 13801 CEDAR ST
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City | LEAWOOD
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State | KS
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Zip | 66224-1119
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Country | US
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Telephone | 913-307-9200
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Fax | 913-307-9200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | KS1599
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2000166654
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3482
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License Number State | FL
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