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General NPI Number Information
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NPI Number | 1316365562
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Entity Type | Organization
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Legal Business Name | SANDRA L EASTER
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 115 W LAUREL ST
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City | INDEPENDENCE
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State | KS
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Zip | 67301-3311
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Country | US
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Telephone | 620-331-9090
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Fax | 620-331-0011
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Provider Business Mailing Address
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Address Line | 115 W LAUREL ST
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City | INDEPENDENCE
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State | KS
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Zip | 67301-3311
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Country | US
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Telephone | 620-331-9090
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Fax | 620-331-0011
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA L. EASTER
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Credential | O. D.
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Telephone | 620-331-9090
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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 | 1958
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1547
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License Number State | KS
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