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General NPI Number Information
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NPI Number | 1083952113
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Entity Type | Organization
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Legal Business Name | KU EYE SURGERY & LASER CENTER, LLC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 7400 STATE LINE RD SUITE 212
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3444
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Country | US
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Telephone | 913-588-2020
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Fax | 913-574-1087
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Provider Business Mailing Address
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Address Line | 7400 STATE LINE RD SUITE 100
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-3444
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Country | US
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Telephone | 913-588-6626
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Fax | 913-588-0888
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN E SUTPHIN
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Credential | MD
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Telephone | 913-588-6606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 4652236
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License Number State | KS
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