MEDICARE: FAMILY EYECARE

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	1054-2	KS
2	152W00000X	Optometrist	2245	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619090792	OTHER	MO	BLUE CROSS BLUE SHIELD
2	1750533006	OTHER	MO	UNITED HEALTHCARE
3	1750533006	OTHER	MO	BLUE CROSS / BLUE SHIELD MO - KC

General Provider Information

NPI Number	:	1750533006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYECARE

Provider Business Mailing Address
First Line	:	1905 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3421
Country	:	US
Telephone Number	:	816-221-5939
Fax Number	:	816-221-8705

Provider Business Practice Location Address
First Line	:	1905 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3421
Country	:	US
Telephone Number	:	816-221-5939
Fax Number	:	816-221-8705

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN H CHRISTY
Credential	:	O.D.
Telephone Number	:	816-221-5939

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	08/03/2011

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Directions to “FAMILY EYECARE ” Practice Location

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