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NPI Code Detail

MEDICARE: DR. BONNIE SHUBERT LARGE O.D.

MEDICARE: DR. BONNIE SHUBERT LARGE O.D.
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
1152W00000XOptometrist1494-3KS
2152W00000XOptometristT03392MO

General Provider Information

NPI Number : 1538190400
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BONNIE SHUBERT LARGE O.D.
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 05/09/2023

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