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General NPI Number Information
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NPI Number | 1598930745
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Entity Type | Organization
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Legal Business Name | CHILDREN'S EYE CARE, P.A.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 4601 W 109TH ST SUITE 250
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1318
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Country | US
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Telephone | 913-491-9123
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Fax | 913-491-6608
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Provider Business Mailing Address
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Address Line | 4601 W 109TH ST SUITE 250
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1318
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Country | US
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Telephone | 913-491-9123
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Fax | 913-491-6608
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID E BRAVERMAN
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Credential | MD
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Telephone | 913-491-9123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0417188
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License Number State | KS
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