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General NPI Number Information
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NPI Number | 1285095125
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Entity Type | Organization
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Legal Business Name | WESTPORT EYECARE LLC
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 4233 ROANOKE RD STE 201
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City | KANSAS CITY
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State | MO
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Zip | 64111-4816
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Country | US
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Telephone | 816-753-2020
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Fax | 816-753-2697
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Provider Business Mailing Address
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Address Line | 4233 ROANOKE RD STE 201
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City | KANSAS CITY
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State | MO
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Zip | 64111-4816
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Country | US
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Telephone | 816-753-2020
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Fax | 816-753-2697
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. RYAN CHRISTOPHER MILES
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Credential | OD
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Telephone | 816-753-2020
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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 | 2005017513
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License Number State | MO
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