DRS Driver & Clark PA
Organization Active NPI Optometrist · Minneapolis, KS
NPI 1104996891 · NPPES record last updated Sep 13, 2013
Key facts
- NPI
- 1104996891
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- KS1325 (KS)
- Legal business name
- DRS DRIVER & CLARK PA
- Practice address
- 407 W 2ND St
Minneapolis, KS 67467-2315 - Phone
- (785) 392-2126
- Fax
- (785) 392-2180
- NPI assigned
- Nov 9, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- DRS DRIVER & CLARK PA
Authorized official
- Name
- Dr. Kenton Ray Driver, OD
- Title
- Doctor
- Phone
- (785) 392-2126
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Practitioners 4
-
Stacy Ann Clark, OD
-
Jenee' Barth, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204000857 | KS | Part B Supplier - Clinic/Group Practice | 7416840392 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Minneapolis, KS; Salina, KS |
National Provider Directory
- Part of
- Doctors Driver and Clar
Locations
407 W 2nd St
Minneapolis, KS 67467
Phone (785) 392-2126
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | KS1325 | KS | Yes |
Addresses
Primary practice location
407 W 2ND St
Minneapolis, KS 67467-2315
Mailing address
407 W 2ND St
Minneapolis, KS 67467-2315
Phone (785) 392-2126
Other names
- Drs Driver & Clark PA
Other providers in Minneapolis, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.