MEDICARE: KANNARR EYE CARE, 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
1	152W00000X	Optometrist	1699	KS

General Provider Information

NPI Number	:	1629209051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANNARR EYE CARE, LLC

Provider Business Mailing Address
First Line	:	101 W 29TH ST STE G
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-2664
Country	:	US
Telephone Number	:	620-235-1737
Fax Number	:	620-230-0358

Provider Business Practice Location Address
First Line	:	2521 N BROADWAY ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-2620
Country	:	US
Telephone Number	:	620-235-1737
Fax Number	:	620-230-0358

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	KARLA TERSINAR
Credential	:
Telephone Number	:	620-235-1737

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	11/04/2024

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Directions to “KANNARR EYE CARE, LLC ” Practice Location

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