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General NPI Number Information
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NPI Number | 1245366939
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Entity Type | Organization
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Legal Business Name | BLUE VALLEY EYECARE, LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/21/2023
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Provider Practice Location Address
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Address Line | 12621 ANTIOCH RD
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City | OVERLAND PARK
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State | KS
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Zip | 66213-1701
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Country | US
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Telephone | 913-814-7707
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Fax | 913-814-7997
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Provider Business Mailing Address
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Address Line | 12621 ANTIOCH RD
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City | OVERLAND PARK
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State | KS
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Zip | 66213-1701
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Country | US
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Telephone | 913-814-7707
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Fax | 913-814-7997
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEIDI ANN REILING
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Credential | OD
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Telephone | 913-814-7707
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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 | KS 1469-3
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License Number State | KS
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Legacy Identifiers
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Identifier #1
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Identifier Code | 26866016
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Identifier Type | OTHER
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Identifier State | KS
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Identifier Issuer | BLUE CROSS BLUE SHIELD
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 26866016
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Identifier Type | OTHER
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Identifier State | KS
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Identifier Issuer | BLUE CROSS BLUE SHIELD
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