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General NPI Number Information
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NPI Number | 1205961919
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Entity Type | Organization
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Legal Business Name | MCBRATNEY OPTICAL BOUTIQUE
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7702 PARALLEL PARKWAY
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City | KANSAS CITY
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State | KS
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Zip | 66112
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Country | US
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Telephone | 913-299-6001
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Fax | 913-299-6001
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Provider Business Mailing Address
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Address Line | 7702 PARALLEL PARKWAY
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City | KANSAS CITY
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State | KS
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Zip | 66112
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Country | US
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Telephone | 913-299-6001
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Fax | 913-299-6001
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHARLES FREDRICK MCBRATNEY
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Credential | OPTICIAN CERT 16255
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Telephone | 913-299-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 999800000001183
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License Number State | KS
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