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General NPI Number Information
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NPI Number | 1295208338
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Entity Type | Organization
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Legal Business Name | BONNIE SHUBERT OD LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 5110 N OAK TRFY
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City | KANSAS CITY
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State | MO
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Zip | 64118-4621
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Country | US
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Telephone | 816-459-7633
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Fax | 816-454-0681
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Provider Business Mailing Address
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Address Line | 14509 ROBINSON ST
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City | OVERLAND PARK
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State | KS
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Zip | 66223-1236
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Country | US
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Telephone | 913-669-6665
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BONNIE SHUBERT LARGE
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Credential | OD
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Telephone | 913-669-6665
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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 |
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License Number State |
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