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NPI Code Detail

MEDICARE: BONNIE SHUBERT OD LLC

MEDICARE: BONNIE SHUBERT OD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NPIOTHERKS1538190400

General Provider Information

NPI Number : 1295208338
Entity Type Code : Organization
Provider Name (Legal Business Name) : BONNIE SHUBERT OD LLC
Provider Business Mailing Address
First Line : 14509 ROBINSON ST
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66223-1236
Country : US
Telephone Number : 913-669-6665
Fax Number :
Provider Business Practice Location Address
First Line : 5110 N OAK TRFY
Second Line :
City : KANSAS CITY
State : MO
Zip : 64118-4621
Country : US
Telephone Number : 816-459-7633
Fax Number : 816-454-0681
Authorized Official
Title or Position : OWNER
Name : BONNIE SHUBERT LARGE
Credential : OD
Telephone Number : 913-669-6665
Provider Enumeration Date : 01/10/2019
Last Update Date : 05/09/2023

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Directions to “BONNIE SHUBERT OD LLC ” Practice Location

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