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General NPI Number Information
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NPI Number | 1629209051
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Entity Type | Organization
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Legal Business Name | KANNARR EYE CARE, LLC
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2521 N BROADWAY ST
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City | PITTSBURG
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State | KS
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Zip | 66762-2620
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Country | US
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Telephone | 620-235-1737
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Fax | 620-230-0358
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Provider Business Mailing Address
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Address Line | 101 W 29TH ST STE G
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City | PITTSBURG
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State | KS
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Zip | 66762-2664
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Country | US
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Telephone | 620-235-1737
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Fax | 620-230-0358
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KARLA TERSINAR
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Credential |
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Telephone | 620-235-1737
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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 | 1699
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License Number State | KS
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