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General NPI Number Information
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NPI Number | 1760536908
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Entity Type | Organization
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Legal Business Name | EYE TO EYE PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/10/2017
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Provider Practice Location Address
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Address Line | 1105 N BUCKNER ST
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City | DERBY
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State | KS
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Zip | 67037-2719
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Country | US
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Telephone | 316-788-9290
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Fax | 316-788-6157
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Provider Business Mailing Address
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Address Line | 1105 N BUCKNER ST
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City | DERBY
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State | KS
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Zip | 67037-2719
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Country | US
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Telephone | 316-788-9290
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Fax | 316-788-6157
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA ANN BRANSTETTER
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Credential | OD
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Telephone | 316-788-9290
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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 | 1002B516
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License Number State | KS
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