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General NPI Number Information
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NPI Number | 1306181367
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Entity Type | Organization
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Legal Business Name | WYANDOTTE FAMILY EYECARE CENTER, LLC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 21 N 12TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66102-5161
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Country | US
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Telephone | 913-342-4405
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Fax | 913-342-4406
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Provider Business Mailing Address
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Address Line | 21 N 12TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66102-5161
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Country | US
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Telephone | 913-342-4405
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Fax | 913-342-4406
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS KELLY SKAGGS
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Credential |
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Telephone | 913-342-4405
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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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