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General NPI Number Information
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NPI Number | 1245382829
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EYECARE - BANNISTER
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5600 E BANNISTER RD RM 188
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City | KANSAS CITY
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State | MO
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Zip | 64192-1000
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Country | US
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Telephone | 816-765-3310
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Fax | 816-765-3181
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Provider Business Mailing Address
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Address Line | 5600 E BANNISTER RD RM 188
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City | KANSAS CITY
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State | MO
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Zip | 64192-1000
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Country | US
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Telephone | 816-765-3310
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Fax | 816-765-3181
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Authorized Official
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Title or Position | MANAGED CARE MANAGER
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Name | DENISE LORRAINE ROYER
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Credential |
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Telephone | 913-696-0092
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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 | TO2880
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License Number State | MO
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