1922493634 NPI number — PREMIER FAMILY EYECARE, LLC

Table of content: (NPI 1922493634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922493634 NPI number — PREMIER FAMILY EYECARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER FAMILY EYECARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRAIRIE EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922493634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5801 W 152ND PL
Provider Second Line Business Mailing Address:
OPTOMETRIST OFFICE
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66223-3257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-228-0111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12801 KANSAS AVE
Provider Second Line Business Practice Location Address:
OPTOMETRIST OFFICE
Provider Business Practice Location Address City Name:
BONNER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66012-9202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-228-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ERKER
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
913-314-8000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1941 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)