MEDICARE: CENTER FOR SIGHT OF NORTHEAST KANSAS, PA

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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD6151	OTHER	KS	PALMETTO GBA
2	110291	OTHER	KS	BCBS OF KS

General Provider Information

NPI Number	:	1720198211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR SIGHT OF NORTHEAST KANSAS, PA

Provider Business Mailing Address
First Line	:	619 SW CORPORATE VIEW
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1233
Country	:	US
Telephone Number	:	785-235-3322
Fax Number	:	785-246-6258

Provider Business Practice Location Address
First Line	:	619 SW CORPORATE VIEW
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1233
Country	:	US
Telephone Number	:	785-235-3322
Fax Number	:	785-246-6258

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN C. MARSH
Credential	:	M.D.
Telephone Number	:	785-235-3322

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/23/2015

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