MEDICARE: SUTHERLIN OPTICAL COMPANY

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	332H00000X	Eyewear Supplier		MO

General Provider Information

NPI Number	:	1982812871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTHERLIN OPTICAL COMPANY

Provider Business Mailing Address
First Line	:	1941 CENTRAL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2029
Country	:	US
Telephone Number	:	816-421-0369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 CENTRAL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2029
Country	:	US
Telephone Number	:	816-421-0369
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN EDWARD SUTHERLIN
Credential	:
Telephone Number	:	816-421-0369

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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Directions to “SUTHERLIN OPTICAL COMPANY ” Practice Location

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