MEDICARE: KELSEY J KLEINSASSER OD

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	200160787	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740278944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY J KLEINSASSER OD

Provider Business Mailing Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 1000
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1713
Country	:	US
Telephone Number	:	816-358-3600
Fax Number	:	816-358-9903

Provider Business Practice Location Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 1000
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1713
Country	:	US
Telephone Number	:	816-358-3600
Fax Number	:	816-358-9903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	03/22/2010

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Directions to “ KELSEY J KLEINSASSER OD” Practice Location

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