MEDICARE: EYRIE ENTERPRISES INC.

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
1	332H00000X	Eyewear Supplier		MO

General Provider Information

NPI Number	:	1376893362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYRIE ENTERPRISES INC.

Provider Business Mailing Address
First Line	:	8502 N GREEN HILLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-1403
Country	:	US
Telephone Number	:	816-741-3937
Fax Number	:	816-741-8801

Provider Business Practice Location Address
First Line	:	8502 N GREEN HILLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-1403
Country	:	US
Telephone Number	:	816-741-3937
Fax Number	:	816-741-8801

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDAL SCOTT SMITH
Credential	:
Telephone Number	:	816-741-3937

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	07/21/2022

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