=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811879059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW HERST
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4109 W 83RD ST
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66208-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-681-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 W 135TH ST
-----------------------------------------------------
City | LEAWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66224-8714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2244
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------