=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427316496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRN MEDICAL READING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2012
-----------------------------------------------------
Last Update Date | 04/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10801 MASTIN ST SUITE 210
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66210-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-956-4900
-----------------------------------------------------
Fax | 913-956-4955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10801 MASTIN ST SUITE 210
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66210-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-956-4900
-----------------------------------------------------
Fax | 913-956-4955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | DR. DAVID S DYER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 913-956-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 04-26713
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------